BUSINESS BEFORE QUESTIONS

Parliamentary Commissioner for Administration and Health Service Commissioner for England (Answer to Address)

The Vice-Chamberlain of the Household reported to the House a message from Her Majesty, as follows:
	I have received  your Humble Address praying that I should appoint Dame Ju l ie Mellor to the offices of Parliamentary Commissioner for Administration and Health Service Commissioner for England. I will comply with your request.

Transport for London (Supplemental Toll Provisions) Bill [Lords] (By order)

Second Reading opposed and deferred until  Wednesday 14 September  (Standing Order No. 20).

ORAL ANSWERS TO QUESTIONS

CABINET OFFICE

The Minister for the Cabinet Office was asked—

Big Society Bank

James Morris: What progress he has made on establishing the big society bank.

Oliver Letwin: I am delighted to be able to tell my hon. Friend that we are making excellent progress in establishing the big society bank. I am equally delighted to be able to tell him that it will be called the Big Society Capital group.
	Big Society Capital announced appointments to the management and board in July. It is now securing Financial Services Authority and state-aid approval, and we expect it to be open for business in the spring.

James Morris: Does the Minister agree that the most important thing about the initiative is that it gets funding to organisations in some of the most deprived communities in my constituency?

Oliver Letwin: My hon. Friend is a noted, effective and passionate advocate of his constituency. It is of course for Big Society Capital itself to decide exactly where it
	places its investment funds, but I have absolutely no doubt that it will want to prioritise social intermediaries who focus on those families who are most vulnerable, and on those individuals and families who are most in need of help.

Albert Owen: Community groups, including not-for-profit organisations, have difficulty establishing community projects because of the complexity of the system to secure funding. Will the big society bank have a dedicated officer to help and assist them, so that small projects in deprived communities have a level playing field?

Oliver Letwin: The hon. Gentleman raises a very real problem, which Big Society Capital has recognised. Right from the beginning of the scheme’s design, Sir Ronald Cohen has insisted, and Ministers have agreed, that it should not directly invest in social enterprises but act as a provider of finance to social intermediaries—whether they are lending banks such as Triodos or other more exotic and interesting new social intermediaries—that already have a retail function and can deal, and know how to deal, with the small groups that need to deal with them.

Government Contracts

Brandon Lewis: What steps his Department is taking to ensure that small and medium-sized enterprises are aware of opportunities to gain Government contracts.

Andrew Bridgen: What steps his Department is taking to ensure that small and medium-sized enterprises are aware of opportunities to gain Government contracts.

Oliver Letwin: We have established Contracts Finder as a one-stop shop, which enables suppliers to find procurement opportunities, tender documents and contracts online and free of charge. We are also piloting a simple method, which I think is called a dynamic market, for suppliers to register online for public sector contracts below £100,000. That will enable small and medium-sized enterprises to compete at minimal cost alongside large suppliers.

Brandon Lewis: Does the Minister agree that, although large companies often find it easy to tender competitively for those contracts, there is a real benefit economically from spending time and effort on encouraging small and medium-sized businesses to bid for such tenders?

Oliver Letwin: I agree strongly with my hon. Friend. There is a temptation to think that it does not matter who provides a public service contract, big or small, but we all have an enormous interest in encouraging small and medium-sized enterprises to engage in the process, because we all have a huge incentive and reason for believing that innovation in public service can lead to more productivity. It is very often the small, innovative companies that engage in innovation, and therefore we need to ensure that we encourage their participation right the way through the process.

Andrew Bridgen: SME information technology companies are reporting back from the Government tendering process that project aims and budgets remain unspecified and that forms are still the size of telephone directories. Can my right hon. Friend assure the House that those concerns will be taken on board, so that this Government can deliver real value from IT projects—something that the previous Government failed to do?

Oliver Letwin: My hon. Friend has actively and aggressively pursued several Government Departments about these issues and I hope that he will continue to do so. He is absolutely right that too much of this still goes on. My right hon. Friend the Minister for the Cabinet Office, who has taken the lead on the issue and deserves great credit for that, has not tried to keep the issue secret—on the contrary, he has tried to open it up.
	We have introduced a “mystery shopper” scheme, which allows suppliers to challenge Government procurers when they see overly bureaucratic processes. I am delighted to be able to tell the House that during the first three months of the scheme, 23 cases of things such as huge telephone-book-sized contracts were investigated and 11 have led to immediate reductions in tedious bureaucracy. All the information about the scheme has been published on the Cabinet Office website.

Bernard Jenkin: Has my right hon. Friend had a chance to read the Public Administration Committee report “Government and IT—‘A Recipe For Rip-Offs’ ”? It points out that we cannot rely on the large systems integrators to involve small and medium-sized enterprises. The Government themselves have to employ people from that sector so that the Government can engage with it directly. That is the only way in which we will get SMEs involved in Government procurement.

Oliver Letwin: As with every product of the Select Committee in which my hon. Friend is so notably involved, we do indeed pay enormous attention to that report. My right hon. Friend the Minister for the Cabinet Office has already taken that set of steps and is already intending to ensure that we have the expertise to do exactly as my hon. Friend recommends. It is absolutely crucial that we get to grips with every large project, and some of them are central to the Government’s policy agenda—in welfare, for example.

Public Bodies Bill

Mark Lancaster: What steps he plans to take to put in place a system of regular review of remaining public bodies following the implementation of the provisions of the Public Bodies Bill.

Nick Hurd: The Government are committed to reviewing non-departmental public bodies every three years. The reviews will provide a much needed, robust challenge for the continuing need of individual bodies and ensure that the body is complying with recognised principles of good corporate governance.

Mark Lancaster: Will the Minister remind the House how much money he anticipates will be saved as a result of the Bill? Given the amount of spending on so many
	quangos, much of which is so wasteful, are we not being slightly modest in our ambitions? Is there not even greater scope in future years to save yet more money?

Nick Hurd: My hon. Friend is entirely right—he should be nudging us to be more ambitious. We have placed on record what we think is a conservative estimate of cumulative administrative savings from reforms already identified of at least £2.6 billion over the spending review period, but we expect that to be a start rather than a finish.

Jenny Chapman: Is the Minister concerned that some of the public bodies may be being abolished with a little too much haste, particularly given the riots in the summer? The Youth Justice Board was very successful in reducing youth offending by around 34%. Does the Minister not worry that we will get rid of some of the bodies in too much of a hurry?

Nick Hurd: The Youth Justice Board still exists. What we have set up with the Public Bodies Bill is a framework and mechanism for enabling reform. Each Department has to come to the House with a case for reform, which needs to be debated and processed through secondary legislation. That is what we have set up, so Parliament will have plenty of opportunity to scrutinise and debate.

Tessa Jowell: In 2009, it was agreed that the office of the chief coroner would be established to improve support for bereaved families. The decision was taken with support from both sides of the House. In the passage of the Public Bodies Bill, the Government have signalled that they intend to abolish the office of the chief coroner before it has even been established. Which organisations are in favour of its abolition?

Nick Hurd: The right hon. Lady knows from our Second Reading debates that there are strong opinions on this subject. I refer her to what I said before; the mechanism that we have set out is for a genuine debate on the proposed reforms. That is what the Bill enables, and she and I, or appropriate colleagues, will have that debate in Committee in forthcoming weeks and months.

Efficiency and Reform Group

Mike Freer: What estimate he has made of the savings to the public purse arising from the work of the Efficiency and Reform Group in 2010-11.

Francis Maude: The Government saved £3.75 billion in their first 10 months after taking office by stopping unnecessary and wasteful spending. We saved £800 million by renegotiating with the biggest suppliers to Government. We cut spending on consultants by 70% and on advertising by 80%. This is just the beginning; there is much more to be done.

Mike Freer: I thank the Minister and welcome the initial savings of the Efficiency and Reform Group. He will be aware, however, of the £1 billion of additional savings that my own research has identified. Will he agree that I could meet the chair of the Efficiency and Reform Group to discuss these savings further?

Francis Maude: The chair of the Efficiency and Reform Group is me, so I will be delighted to meet my hon. Friend, who, when he was leader of Barnet council, showed how much can be done. We do, absolutely, have a huge amount to learn from what is being done best in local government, particularly the sort of savings that can be made by much better use of office accommodation. It is such a pity that when the current Leader of the Opposition was Minister for the Cabinet Office he did not do this stuff himself. The country would be in less of a mess and the public finances would be in better shape if he had done his job properly.

Jon Trickett: Of course everybody welcomes cuts to wasteful expenditure. However, will the Minister explain why the Cabinet Office website indicates that in January a contractor charged the taxpayer £5,867.66 for flying flags? Will he explain why the Government paid a single taxi fare of £324.14, which would almost get me from here to Yorkshire and back again? Finally, will he explain why the taxpayer paid £181 for a single individual’s eye test? What a waste of money.

Francis Maude: I shall be absolutely delighted to provide the hon. Gentleman with full and detailed replies. I just point out to him, however, that if we had not opened up public spending to public scrutiny, he would not have a prayer of even asking the question.

Stephen Metcalfe: Proxima, a small software company in my constituency, has the potential to offer real efficiency savings in the use of Government software. Its initial discussions with the Department have been positive, but they have now stalled. Will my right hon. Friend agree to meet me and my constituents to see how we can save the Government millions by better use of their resources?

Francis Maude: My hon. Friend has raised an important point, and I will be very glad to meet him to discuss it. There is a huge amount we can do to use IT resources much, much better. Far too often in the past, the Government were reinventing the wheel by buying new systems and not reusing what they had already spent money on. That will now cease.

Civil Service (Voluntary Severance)

Michael McCann: What estimate he has made of the number of civil servants who will leave the civil service on voluntary severance terms in 2010-11.

Francis Maude: We aim to minimise compulsory redundancy. We reformed the civil service compensation scheme so that, for the first time, voluntary redundancy was more attractive than compulsory redundancy, which was impossibly expensive under the scheme left in place by the previous Government. We estimate that in early 2010-11 11,200 civil servants left the civil service on the new terms.[Official Report, 8 September 2011, Vol. 532, c. 3MC.]

Michael McCann: I thank the Minister for that answer. Let me place on record the fact that he will share the objective that all severance packages are voluntary. Nevertheless, I am receiving from civil servants who
	work in my constituency evidence that they have been dissuaded from volunteering for a redundancy package because parts of their accrued service do not count for the final compensation package. Will the Minister ensure that maximum flexibility is deployed in order to allow us to reach the goal of all departures being voluntary?

Francis Maude: I can confirm that staff in the Crown Agents have always been outside the civil service compensation scheme. In April, I used the powers available to me under the scheme rules to allow service in the Crown Agents to count for compensation purposes for the voluntary schemes currently being run by the Department for International Development. I am aware that there are a few cases in which questions have arisen around service before joining the Crown Agents. My officials are actively engaged in clarifying what commitments were made at that time to these staff.

Public Disorder (Financial Cost)

Jonathan Ashworth: What estimate he has made of the financial cost to the voluntary and community sector organisations of recent public disorder in England.

Nick Hurd: Since the riots, we have remained in close contact with our strategic partners, who are feeding in information about the impact of the riots on community groups. I have a meeting next week with community groups and sector representatives to discuss that impact and the way forward.

Jonathan Ashworth: I am grateful to the Minister for that answer. At the height of the disturbances that hit Leicester, the Age Concern ambulance bus was torched. Despite what the Prime Minister indicated to me in his statement of 11 August, Age Concern is not eligible for the compensation schemes. Will the Minister look urgently at setting up a compensation scheme for charities so that Age Concern in my constituency can replace its ambulance bus as quickly as possible?

Nick Hurd: I was as shocked as anyone by the torching of the Age Concern ambulance. My understanding is that under these circumstances, damages are recoverable from the high street support scheme. I have been informed that officials have sent that information through. I would be very happy to meet the hon. Gentleman and representatives of Age Concern if there are continued problems with this issue.

David Evennett: Does my hon. Friend agree that voluntary organisations are the backbone of our local communities and that any damage to their property or organisation diminishes their opportunity to assist the individuals and groups that are most in need?

Nick Hurd: I could not agree more with my hon. Friend, which is why I am meeting many sector representatives and community groups next week to discuss the impact and the way forward. He knows as well as I do that we are doing a huge amount to support community organisations through deregulation and by making it easier for them to access finance.

Roberta Blackman-Woods: How much money does the Minister think he will have to put into the national citizen service to prevent future riots? How will he ensure that that is not done at the cost of general voluntary and community services that support young people, especially given that they are incurring additional costs in helping communities to rebuild after the riots and are subject to Government cuts?

Nick Hurd: We are hugely enthusiastic about the national citizen service; much more, apparently, than the Opposition Front Bench. The experience from this summer is that it has been a fantastic experience for young people, connecting them with a chance to do something really positive in their communities. We are piloting it, but have to proceed cautiously because a lot of taxpayers’ money is involved. As the Prime Minister has made quite clear, we are keen to expand it as fast as we can.

National Citizen Service

Caroline Nokes: What recent progress he has made on the national citizen service pilots.

Nick Hurd: We are absolutely delighted with the progress of the national citizen service. About 8,500 young people enjoyed an extremely positive experience this summer. The feedback has been fantastically positive and we will publish an evaluation report shortly on this year’s pilots.

Caroline Nokes: I thank the Minister for that response. Will he confirm that he will look to involve organisations such as the YMCA, which has a fantastically strong track record of providing constructive activities for young people, in the delivery of the scheme?

Nick Hurd: I share my hon. Friend’s high regard for the YMCA and lots of other youth organisations across the country. As I said, we are ambitious to expand the national citizen service and are looking to commission up to 30,000 places next year. We are actively reviewing a list of applications and bids from a great diversity of suppliers. We will announce the results of that shortly.

Huw Irranca-Davies: I know that the Minister is still working out the fine details of the scheme, but may I urge him not to reinvent the wheel, but to make the best use of the Prince’s Trust and the Duke of Edinburgh’s award scheme, of which I am a gold member? As well as not reinventing the wheel, I urge him not to break the spokes in the wheel by shattering youth service provision throughout the country as very good schemes go to the wall under this Administration.

Nick Hurd: I should make it clear that we are deliberately offering 16-year-olds in this country something new and distinctive. If the hon. Gentleman listens to the kids on the programme this year, he will hear that they see it as being very different from the Duke of Edinburgh’s award and the Prince’s Trust. It is set up to be different, and that is why we are piloting it. As I said, we are extremely enthusiastic about the feedback.

Several hon. Members: rose —

Mr Speaker: Order. There are far too many private conversations taking place in the Chamber. The House must come to order and hear Mr Mel Stride.

Topical Questions

Mel Stride: If he will make a statement on his departmental responsibilities.

Francis Maude: As Minister for the Cabinet Office, I am responsible for the public sector Efficiency and Reform Group, civil service issues, industrial relations, strategy in the public sector, Government transparency, civil contingencies, the civil society and cyber-security.

Mel Stride: Okehampton, in my constituency, has recently seen unemployment treble virtually overnight, although the figure has now decreased dramatically due to local action. It is holding a very important event this week, “Okehampton Works”, bringing together public, private and voluntary organisations to focus on employment, which is an important step towards the big society locally. Will my right hon. Friend join me in visiting Okehampton to meet, and learn from, those who have pioneered that important initiative?

Francis Maude: I should be delighted for either myself or the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Ruislip, Northwood and Pinner (Mr Hurd), to join my hon. Friend in Okehampton to discuss those very issues. There is a huge amount that can be done.

Mr Speaker: I call Graham Stringer. He is not here.

Chris Bryant: One quango that has done a really good job since it was brought in by the Labour Government is the Security Industry Authority, which licenses bouncers outside pubs. One role that it has not yet been given is the licensing of private investigators. We have seen over the past year that some private investigators are very good people, but some of them are the scum of the earth. Should we not be licensing them and giving that power to the authority?

Francis Maude: Whatever the merits of the hon. Gentleman’s point, it is one that he should make to my right hon. Friend the Home Secretary, who has responsibility for these matters.

Karl McCartney: In light of the excellent work in Lincoln this summer of the pilot national citizen service managed by the Lincolnshire and Rutland Education Business Partnership, can my hon. Friend assure me that careful consideration has been given to the EBP’s bid for next year, which I wholeheartedly support, so that it can be the deliverer of the NCS for the whole of Lincolnshire in 2012?

Nick Hurd: I am grateful to Lincolnshire and Rutland Education Business Partnership for the excellent work that it has done this summer, which is a really good example of communities working together to support the NCS. As
	I have said before, we are giving careful consideration to all bids received to run the 2012 pilots and will be making an announcement very shortly.
	[Interruption.]

Mr Speaker: Order. There really is far too much noise in the Chamber. It is very discourteous to the Member asking the question and the Minister whose answer we want to hear. I hope the House will show some respect for Mr Sammy Wilson.

Sammy Wilson: What arrangements does the Minister intend to put in place to ensure that places such as Northern Ireland benefit from the opportunities presented by the big society bank?

Nick Hurd: I was in Belfast just a few weeks ago, at Hillsborough castle, talking about just that to a section of community organisations and social enterprises that were fascinated by the big society bank. We made it very clear that it was open for business in Northern Ireland.

Jason McCartney: I enjoyed a very rewarding week of volunteering in my constituency during the summer with Mencap, the National Trust, Kirkwood hospice, the Forget Me Not Trust and many more. Does the Minister agree that volunteering should be a key component of the national citizen service?

Nick Hurd: I congratulate my hon. Friend on the sterling example that he has set others. Of course, one of the purposes of the national citizen service is to connect young people with their power to make a positive difference in their communities. If he had visited some of the pilots that I did, he would have been absolutely inspired by the enthusiasm with which they undertook that task.

Duncan Hames: In opening access to public data on the performance of our publicly subsidised railways, does the Minister recognise that real-time running information would be even more powerful in driving innovation that would aid the travelling public? Will he get train operators to be more open with such public data?

Francis Maude: My hon. Friend makes a powerful point. These are services that rely on public subsidy, and that information is incredibly valuable and capable of providing enormous benefit to the users of public transport. It can drive more passengers on to public transport, which we all want, so it is in not only the public interest but the operators’ interest to make such data available.

Gavin Barwell: Further to our meeting in May, may I ask my right hon. Friend what progress has been made with the relocation of part of the central Government estate from central London?

Francis Maude: At this stage we are concentrating on simply reducing the footprint of the Government’s property estate, which was allowed to grow massively out of control under the last Government because there were no controls whatever. Rather than looking to relocate,
	at this stage we are simply looking to reduce what the Government occupy. I know that Croydon, which my hon. Friend represents vigorously, is a very good location out of central London for Government services to operate from.

Sajid Javid: Small and medium-sized enterprises in my constituency warmly welcome the steps that the Government are taking to make it easier for them to win Government contracts, but they also need better access to finance to win such contracts. What steps is my right hon. Friend taking to help with that?

Oliver Letwin: My hon. Friend is absolutely right that without the finance, SMEs cannot take part. I am delighted to be able to tell him that in the first half of the year, SME lending has almost lived up to the target set in the Merlin agreement for SMEs—it is within £1 billion—which is a major achievement.

Nicky Morgan: Does my hon. Friend agree that the promotion of youth organisations such as the Passion youth centre in Shepshed, which are often set up by churches, should be a cornerstone of the Government’s response to the riots over the summer?

Nick Hurd: I should certainly like to join my hon. Friend in congratulating the Passion youth centre and the local churches that support it. That seems to be an excellent example of the community pulling together to make better use of an old facility, which is exactly the type of thing that we are trying to encourage through the Localism Bill, Big Society Capital and the Community First grant programme.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Ian Austin: If he will list his official engagements for Wednesday 7 September.

David Cameron: I am sure that the whole House will wish to join me in paying tribute to those who have fallen in Afghanistan since we last met for Prime Minister’s questions: Lance Corporal Paul Watkins, from 9th/12th Royal Lancers; Corporal Mark Palin, from 1st Battalion The Rifles; Marine James Wright, from Juliet Company, 42 Commando, Royal Marines; Lieutenant Daniel Clack, from 1st Battalion The Rifles; and Sergeant Barry Weston, from Kilo Company, 42 Commando, Royal Marines. We should also remember Senior Aircraftman James Smart, from No. 2 (Mechanical Transport) Squadron, RAF Wittering, who died in a road traffic accident in Italy on 20 July while supporting operations in Libya. I pay tribute to their outstanding courage and selflessness. They have each given their lives serving our country and making our world more safe and secure. Our thoughts and deepest sympathies should be with their families, their friends and their colleagues.
	This week, we also reach the 10th anniversary of the terrible atrocities of 11 September 2001, so we should remember all those who lost their lives that day, and all those who have died in pursuit of a safer future throughout the last decade.
	This morning I had meetings with ministerial colleagues and others, and in addition to my duties in this House, I shall have further such meetings later today.

Ian Austin: The whole House will agree with the tributes that the Prime Minister has just made to members of the armed forces who have made the ultimate sacrifice defending our country.
	Earlier this week, the Government pushed through legislation that says that terror suspects must be given access to mobile phones and the internet and that ends relocation orders, so that such suspects cannot be kept out of London in the run-up to the Olympics or the Queen’s jubilee without emergency legislation. Will not decent, law-abiding people out there be shocked to discover that the Prime Minister is weakening protection for them while pushing through what many people will think is a charter of rights for would-be terrorists?

David Cameron: I do not agree with that. We consulted very carefully with the police and the security services in order to try to get to a better position, because frankly, control orders did not have the confidence of the public and did not work in far too many cases. The arrangements that we have put in place will keep this country safe and have greater public confidence.

Guy Opperman: May I thank the House and all my Hexham constituents for their messages of support while I was temporarily in hospital? I am now fully recovered, thanks to the outstanding care of the NHS and its hard-working doctors and nurses. Does the Prime Minister agree with me, as many doctors and nurses did, that it must be our mission to improve and reform the NHS, so that the service that we so cherish will improve with the challenges that we face ahead?

David Cameron: May I say how good it is to see my hon. Friend back in his place and fully recovered? He is right: the point of our health reforms is to put doctors in charge, give patients greater choice, and heal the divide between health and social care. I believe that they will lead to a stronger NHS and better outcomes for patients.

Edward Miliband: May I begin by joining the Prime Minister in paying tribute to our brave servicemen who have given their lives over the summer: Lance Corporal Paul Watkins, from 9th/12th Royal Lancers (Prince of Wales’s); Corporal Mark Palin, from 1st Battalion The Rifles; Marine James Wright, from Juliet Company, 42 Commando, Royal Marines; Lieutenant Daniel Clack, from 1st Battalion The Rifles; Sergeant Barry Weston, from Kilo Company, 42 Commando, Royal Marines; and Senior Aircraftman James Smart, from No. 2 (Mechanical Transport) Squadron, RAF Wittering. All of them demonstrated tremendous bravery and courage in the line of duty, and we send our deepest condolences to their families and friends.
	Let me also join the Prime Minister in remembering all those who died in the terrorist attacks of 11 September 2001. We all said at the time that we would never forget, and it is right that we pay particular attention on this the 10th anniversary of 11 September, so that for the victims and their families we show that we are true to the words that we spoke in the aftermath of those terrible attacks.
	As the House returns from the recess, I also thank all our policemen and policewomen who did such a tremendous job in the riots over the summer, and it is on the subject of policing that I want to start my questions to the Prime Minister. We learned last night that the Prime Minister now wants to hold his elections for police commissioners not alongside local elections, as originally intended, but in November next year. How much extra money does he expect that to cost?

David Cameron: It will cost an extra £25 million. The money will not be taken from the police budget.

Edward Miliband: So the Prime Minister is making a bad policy worse by wasting money. If he wanted to postpone the elections, he could easily have decided to hold them in May 2013; and, indeed, subsequent elections will be held in May 2016. Will he tell us why he has decided to waste his money in this way?

David Cameron: It is important to get the policy right, and to make sure that it works. Let us be clear. First of all, why are the Opposition so frightened of an election? What have they to fear?
	The right hon. Gentleman called this bad policy. Let me tell him what was said by his own shadow Policing Minister. The hon. Member for Gedling (Vernon Coaker) said that
	“only direct election, based on geographic constituencies, will deliver the strong connection to the public which is critical”.
	Why is the right hon. Gentleman so frightened of an election and proper police accountability?

Edward Miliband: We know what the public up and down this country know: this is the wrong priority for the country. What did we see during the riots? We saw visible, effective policing. Now the Prime Minister tells us that the country cannot afford the current police budgets, and that we must cut the number of police officers by 16,000. However, he tells the country that it can afford £100 million and more as a result of his decision to waste money on 42 elected politicians earning more than £120,000 a year. That could pay for 2,000 extra police officers. Is not the truth that this is the wrong priority at the wrong time for the country?

David Cameron: As ever, the right hon. Gentleman has got his figures completely wrong. The police authorities of whom only 6% of the country have actually heard will be abolished, and that will save money.
	Let me put it to the right hon. Gentleman again. Why is he frightened of direct elections that will make the police accountable? He was responsible for the last Labour manifesto, and this is what the last Labour Prime Minister said:
	“the Home Secretary will bring forward proposals for directly elected representatives to give local people more control over policing”.—[Official Report, 14 May 2008; Vol. 475, c. 1388.]
	Why the U-turn?

Edward Miliband: We know that the Prime Minister has got the wrong priorities on the police and that he is refusing to back down. However, he has got the wrong priorities not just on the police, but on the health service as well. Can he tell us why the number of people who have had to wait longer than six months for an operation has gone up by more than 60% since he came to office?

David Cameron: I am not surprised that the right hon. Gentleman wants to change the subject, because on policing he was having his collar felt as he has done a complete U-turn on the policy he used to be committed to.
	As I said some moments ago, in our health service we are seeing more cancer patients get treatment, more doctors in our NHS, fewer bureaucrats, a reduction in mixed-sex—[Interruption.] I know Labour Members do not like hearing—[Interruption.]

Mr Speaker: Order. There is far too much noise in what is beginning to sound like orchestrated heckling. [Interruption.] Order. It is profoundly discourteous and it should stop.

David Cameron: The trouble is that the Opposition do not like hearing good news about what is happening in the national health service. The fact is that waiting times for outpatients have actually fallen since the last election.

Edward Miliband: That was a complete non-answer; the Prime Minister cannot even answer the questions. We are talking about people up and down this country who have been waiting longer for their operations. [Interruption.] The Government Chief Whip shouts from a sedentary position; he should care about these people who have been waiting longer for their operations. Let me tell the Government Chief Whip and the whole Government Front Bench what we are talking about. Between June 2010 and June 2011, the number of people waiting more than six months for an operation was up by 42% for those waiting for a heart operation, up by 62% for those waiting for orthopaedic operations, and up by 72% for those waiting for eye surgery. The country and I are just asking for a simple explanation from the Prime Minister: why has it happened?

David Cameron: The explanation is that the amount of time that people are waiting for an outpatient operation has actually gone down; that is what has happened. As the right hon. Gentleman knows, we have targets for 90% of people to get their treatment within 18 weeks, and those targets are being met. He may not like the truth, but that is the truth, and I have to say to him that that is why we now see the Royal College of General Practitioners, the Royal College of Physicians and the Royal College of Nursing all supporting our health reforms. We even see Lord Darzi, the former Health Minister, supporting our health reforms. Labour has got itself into a position of opposing all reform to the NHS and opposing the extra money into the NHS; that is its position.

Edward Miliband: I think the Prime Minister has convinced the country that he is on another planet from them. He had his holidays interrupted—fair play to
	him—but he took time off from his holiday to tell the
	Western Morning News 
	what he has just repeated: that the
	“whole health profession is on board for what is now being done.”
	I have to ask: does he read the newspapers, because only on Tuesday of this week the British Medical Association, the Royal College of GPs and the Royal College of Midwives all rejected his Bill? And that was only this week. The truth is that under this Government we are seeing two reckless and needless reorganisations of our public services: police numbers down and waiting lists up. Under Labour, we saw police officers up and waiting lists down. Why does he not do the right thing for the future of our public services, and scrap both of these disruptive and dangerous plans?

David Cameron: Is it not interesting that he does not dare in six questions to mention the economy? On our health reforms, let me quote what the man his Government plucked from the NHS to run the Department of Health, Lord Darzi, says:
	“The proposals from the NHS Future Forum, and supported by the Government, have recast the reforms in”
	the right
	“direction and are to be welcomed.”
	So now we have the Royal College of GPs, the physicians, the nurses and people working in the health service supporting the changes we are making, and Labour wanting to cut the money and also cut the reform. Isn’t it no surprise that the shadow Health Secretary—it is traditional to quote the shadow Health Secretary on these occasions—said this:
	“It’s a tough fact of life…that what Labour says matters less than what almost anyone else says”?
	I couldn’t have put it better myself.

Helen Grant: Does the Prime Minister agree that building stronger families and communities is absolutely essential and key to dealing with antisocial and delinquent behaviour?

David Cameron: My hon. Friend is absolutely right. This is important and I am sure that there will be all-party agreement on it. As well as having a tough response from the criminal justice system to the riots—we have seen that tough response, with some exemplary sentences handed out very rapidly by the courts system; I praise all those who have been involved in speeding up the justice system—at the same time we need to do more to strengthen communities, to strengthen families, to increase discipline in schools and to make sure that our welfare system supports responsible behaviour rather than irresponsible behaviour. We will be bringing forward proposals along those lines and I hope that they will have support from everyone in this House.

Jonathan Ashworth: Before the summer, the Prime Minister took part in a TV documentary that highlighted fears of crime and antisocial behaviour on the Saffron Lane estate in my constituency. Does he expect crime and antisocial behaviour on that estate, and across Leicester, to increase or decrease when he cuts 200 police officers from the Leicestershire force?

David Cameron: I want to see crime and antisocial behaviour go down. Let me just remind the hon. Gentleman that today only 12% of police officers——only one in 10—are on the beat at any one time. There are 25,000 police officers in back-office jobs, not on the front line. We all have a responsibility to try to get our budget deficit under control. His party is committed to a £1 billion cut in the police. What we have to do is recognise that this is about getting officers on to the front line—that is the debate we should be engaged in.

David Burrowes: In the wake of the riots, may I commend the Government’s and Mayor of London’s support for high streets, such as those in Enfield, which were badly hit? Is this not a good time to support the forthcoming global day of prayer, which in London will be taking place at Wembley?

David Cameron: I certainly pay tribute to what the Mayor has done and what the Department for Communities and Local Government has done to make sure that there is money available for rebuilding our communities. The good thing about the £20 million high street support scheme, which my hon. Friend mentions, is that 29 local authorities have already registered for it. I hope that we will see the money being spent quickly to help rebuild our high streets.

Gloria De Piero: Does the Prime Minister support the closure of local police stations?

David Cameron: It is up to chief constables to work out how best to police their areas, but what I am finding from talking to police constables up and down the country is that they want to put their resources into visible policing on the streets. They have got the support of a Government who are cutting the paperwork, reforming the pay and reforming the pensions—taking the difficult decisions that will make sure that we have more police on our streets than we ever would under Labour.

John Baron: Will the Prime Minister join me in sending a very clear message to the Travellers at the illegal Dale Farm site: we all hope that they move off peacefully in order to avoid a forced eviction but if they do not do so, they should be in no doubt that the Government fully support Basildon council and Essex police in reclaiming this green belt land on behalf of the law-abiding majority?

David Cameron: I certainly give my support to Essex police and to all the county and district councils that have been involved, and I pay tribute to my hon. Friend for the very hard work he has put in on this issue. What I would say is that it is a basic issue of fairness: everyone in this country has to obey the law, including the law about planning permission and about building on green belt land. Where this has been done without permission it is an illegal development and so those people should move away. I completely agree with the way in which he put his question.

John Woodcock: The Prime Minister opposed Labour’s anti-gang laws, but then the riots occurred and he decided to strengthen them. Now he wants to weaken
	anti-terror laws by scrapping relocation powers. What will have to happen before he is prepared to admit that the mess he is replacing them with is putting national security at risk?

David Cameron: I simply do not accept what the hon. Gentleman says. In our review of control orders, we listened extremely carefully to MI5, the security services, the Metropolitan police and all those involved. There was a full review process to make sure that we could have a system that is legal—that is vital because the courts unpicked so many of the last Government’s changes—that the public can have confidence in and that will keep us safe.

Heather Wheeler: On the day when 200 people from Bombardier in Derby are here to hear whether we can change the arrangements for the Thameslink contract, can the Prime Minister give us some hope about future contracts and about changing the tender arrangements—the mess that we were left in by the previous Government?

David Cameron: I certainly want to do everything I can to help Bombardier, which is an excellent company that employs people in Derbyshire and has done a brilliant job as an engineering business in this country for so many years. Before people from the Labour party start shouting, let me remind them that this procurement process was designed and initiated by the previous Government. It is no good their trying to shuffle off their responsibility—it is their responsibility.

Thomas Docherty: Why do the Government not agree with the police that children as young as seven should be banned from having shotgun licences?

David Cameron: I think we should enforce proper rules on gun licences, including shotgun licences. We always keep these rules under review and if they need toughening, I will happily look at that.

Nadine Dorries: The Liberal Democrats make up 8.7% of this Parliament and yet they seem to be influencing our free school policy, health and many issues including immigration and abortion. Does the Prime Minister—[ Interruption. ]

Mr Speaker: Order. The question from the hon. Lady will be heard.

Nadine Dorries: Does the Prime Minister think it is about time he told the Deputy Prime Minister who is the boss? [ Interruption. ]

Mr Speaker: Order. I wanted to hear the question, but I want to hear the Prime Minister’s answer.

David Cameron: I know that the hon. Lady is extremely frustrated about the—[ Interruption . ] Perhaps I should start all over again—[ Interruption. ] I am going to give up on this one.

Nicholas Dakin: With the Future Jobs Fund and education maintenance allowance having been scrapped, the number of young
	people not in education, unemployment and training is at a record high of 18.4% on the Prime Minister’s watch. When will things get better for our young people?

David Cameron: Clearly, we face a difficult situation in terms of youth unemployment. Let us be clear that the situation was getting worse during the economic good times, and there was a 40% increase in youth unemployment over the time of the previous Government. What we are seeing today is a disturbing increase in the number of those not in employment, education and training over the age of 18, but under the age of 18 that number is coming down. The steps that we are taking are to improve schooling, to raise the participation age to 18 and massively to increase the level of apprenticeships to 360,000 starts this year. We are also introducing the Work programme, which is the biggest back-to-work programme that has taken place in this country since the 1930s and it will also be made available to young people who are in danger of being left out of employment, education and training.

John Stevenson: I have been working with local businesses, my councils and other organisations to help promote, expand and grow the Carlisle economy. Clearly, given the economic background, it is imperative that we grow both the local and national economy. Will the Prime Minister tell us what new measures the Government will introduce to help promote such growth?

David Cameron: I am grateful to my hon. Friend and I enjoyed seeing at first hand what is happening in Cumbria to try get the local economy moving. The action we are taking obviously includes the cuts in corporation tax, the regional growth fund and the enterprise zones. Specifically for Cumbria, the money we are investing for superfast broadband will really help that county, particularly the most rural and far-flung parts, and will ensure that small businesses can benefit throughout the county.

Mark Tami: DNA and CCTV played a vital role in the arrest of many of the looters. Why is the Prime Minister undermining that in the Protection of Freedoms Bill?

David Cameron: We are not.

Alan Beith: When my right hon. Friend the Prime Minister comes to consider next week’s Vickers report on the banks, which have been rescued with fantastic amounts of taxpayers’ money, will he have no truck with the banks’ argument that they cannot be reformed to prevent another crisis because they are having such a struggle coping with the crisis they have already created? Surely never again should British taxpayers have to bail out banks that are too big to fail.

David Cameron: My right hon. Friend is entirely right that the Government must take action to reform the banks, and that is what we are doing. We have already set out how we are getting rid of the tripartite structure that failed so badly under the previous Government, how we are putting the Bank of England back in charge, and how we are making sure that, as he put it, we cannot have in the future these catastrophic
	bank failures that cost the taxpayer so dear. We are looking forward to receiving Professor Vickers’ report. It seems to me there are two vital things we have to secure—a safe and secure banking system for the future, but also proper bank lending, including to small businesses, right now in our economy. That is what Government policy will be aiming for.

Grahame Morris: The Prime Minister will be aware that his Government are consulting on their changes to housing benefit claims under the criteria of under-occupancy. This will adversely effect 450,000 disabled people, including 33,000 in the north-east alone, who stand to lose on average £676 a year. A substantial number will be affected in my constituency. How does this policy meet his Government’s fairness test?

David Cameron: We are making a specific exclusion to deal with people who have carers living in the home, but we do have to reform housing benefit. I think the whole House knows, frankly, that housing benefit was one of those budget items that was completely out of control. In some parts of London, we had families claiming £60,000, £70,000 and £80,000 in housing benefit just for one family, so this does need to be reformed. It is no good for the Labour party—

Edward Balls: How many?

David Cameron: Frankly, too many. And it is no good for the Labour party to complain about every single reduction to public spending when it left us with the biggest budget deficit in Europe.

Mark Reckless: The Prime Minister has listened to Liberal Democrat colleagues by delaying police elections until November next year. Will he now listen to Conservative colleagues and take the opportunity to hold a referendum on Europe?

David Cameron: That is an ingenious way of putting the question. As I explained yesterday, I want us to be influential in Europe about the things that matter to our national interest—promoting the single market, pushing forward for growth and making sure that we get lower energy prices. Those are the things that we will be fighting for, but I do not see the case for an in/out referendum on Europe. We are in Europe and we have got to make it work for us.

Dave Watts: Does the Prime Minister agree with his housing Minister that due to the economic policies of the Government, we now have a growth crisis? When he does a U-turn, will he choose to cut VAT, which is Labour’s policy, or to give tax cuts to the rich?

David Cameron: The hon. Gentleman obviously has not had time to read this great tome, which points out that increasing VAT was Labour’s policy at the last election. What he should focus on is the fact that the person responsible for Labour’s economic policy at the last election has said it had no credible policy whatever. The problem for Labour is that absolutely nothing has changed.

Michael Ellis: Will the Prime Minister join me in congratulating Members from both sides of the House and in both Houses on their generosity in responding to the letter from Mr Speaker and the Lords’ Speaker in supporting a gift for Her Majesty the Queen for her forthcoming diamond jubilee from this Parliament?

David Cameron: I am delighted to join my hon. Friend in praising everyone who contributed to this very imaginative and sensible gift for Her Majesty’s diamond jubilee. Perhaps I could pay particular tribute to him because he has worked so hard to make this work. I think it will be a fitting tribute and it is something that the country should focus on. To have a diamond jubilee is an extraordinary thing for us to be able to celebrate in our lifetimes.

Barry Gardiner: With electricity and gas bills going up by 20%, and with 6 million families in this country now facing fuel poverty, does the Prime Minister still think it was right to cut the winter fuel payment to pensioners by £100?

David Cameron: Let us be clear: we are going ahead with the winter fuel payment set out by the previous Labour Government in their Budget. At the same time, we are increasing the cold weather payments on a permanent basis, so this Government are being more generous than the previous Government.

Simon Wright: In seeking to address the economic recovery, is it better to help those who are taxed on incomes as little as £150 a week, or those who, after tax, take home around 10 times that amount?

David Cameron: The hon. Gentleman makes a good point. Let me just point out two things that we have done that are totally in line with that, one of which is to lift 1 million people out of income tax altogether—that is a coalition commitment that we have been delivering on. The second thing, when it comes to tax credits, is that we have increased, over two years, by £290 the tax credits that go to the poorest families in our country. That is why we have managed to take difficult decisions—everyone knows we have had to take difficult decisions—without an increase in child poverty. In better economic times, under the previous Government, child poverty actually went up.

Diana Johnson: Bringing Siemens, manufacturing wind turbines, to the Humber is vital for jobs and a breakthrough on renewables, which will hopefully increase the UK industry in this area. Local councils and businesses are doing everything they can to attract Siemens to the area, but we face very strong foreign competition. Will this Government do what the last Government did and back this bid? Will the Prime Minister do everything he can to secure Siemens coming to Hull?

David Cameron: I absolutely agree with the hon. Lady for raising this issue. I think it is vital for the future of our economy and the future of the area that she represents. I met Members of Parliament from Humberside to discuss the issue. I have myself spoken to the head of Siemens about the importance of this
	investment going ahead. We are continuing the extra money going into ports to help the development of this industry and we back it all the way.

Amber Rudd: At a meeting this morning with organisations working in the horn of Africa, representatives expressed their gratitude for the fact that the British public have been so generous and the Department for International Development has provided such leadership. That famine is continuing to become more severe. Will the Prime Minister ensure that the Government continue to provide international leadership to help the people in east Africa?

David Cameron: I can certainly give my hon. Friend that assurance. The response of the British public has been remarkable. These are difficult economic times, but they have shown an incredible generosity and led the world in the contributions that they have made. And because this Government, again in difficult economic times, have made the decision to fulfil our pledge of reaching the level of 0.7% of national income going into aid, we are also leading the world in the amount of money that we are putting into the horn of Africa to vaccinate children, to save lives and to recognise that this is an ongoing humanitarian crisis.

Huw Irranca-Davies: Does the Prime Minister agree that his housing Minister is an absolute star? In the face of declining planning permissions for new build homes, in the face of fewer new homes being built in the previous 12 months than in any year of Labour’s programme of administration for house building, his Minister’s great idea is to urge councils to build more moorings for houseboats. Fantastic.

David Cameron: I thought the hon. Gentleman was doing so well till he got all political. I think there should be agreement across the House that house building is too low in this country, and it is a shocking statistic that the typical first-time buyer is now in their mid-30s. So we do need change, we do need more houses to be built, and I think my housing Minister is doing a first-class job.

Matthew Offord: While much attention is being paid to the military activities occurring in Libya over the summer, will the Prime Minister join me in congratulating Captain Steve Norris and the crew of the Royal Fleet Auxiliary’s Wave Ruler in the work they are doing combating drugs in the Caribbean? Not only did they intercept £50 million of cocaine over the summer, but they have also been helping humanitarian efforts in the Overseas Territories following Hurricane Irene.

David Cameron: My hon. Friend makes an important point. While we obviously should focus on and praise the incredible work that our services have done in Libya and Afghanistan, there are the ongoing tasks. He talks about drug interdiction in the West Indies. There is also the task of protecting the Falkland Islands. There is the work that we are doing to prevent piracy off the horn of Africa. In all these tasks people are giving a huge amount of time and effort, and we should praise and thank them for what they do.

Point of Order

Tessa Jowell: Questions 1 and 3 on the original future day listings for oral questions to the Minister for the Cabinet Office concerned proposals to abolish the Youth Justice Board and the office of the chief coroner—vital bodies scheduled to be removed under the Public Bodies Bill. The Government transferred the questions to other Government Departments. Do you, Mr Speaker, not agree that the Opposition should be able to hold the Minister for the Cabinet Office to account on these specific and unpopular proposals?

Mr Speaker: I am grateful to the right hon. Lady for her point of order. I certainly agree that Ministers should be held to account. The House will know that transfers are matters for the Department concerned, not for the Speaker, although I am concerned that such transfers should be made in good time. The right hon. Lady’s point will have been heard and noted on the Treasury Bench.

BILL PRESENTED
	 — 
	European Union Act 2011 (Amendment) Bill

Presentation and First Reading (Standing Order No. 57)
	Mr William Cash, supported by Mr Bernard Jenkin, Mr John Whittingdale, Mr John Redwood, Geoffrey Clifton-Brown, Mr Greg Knight, Mr Graham Stuart, Mr Richard Shepherd, Jacob Rees-Mogg, Chris Heaton-Harris, Zac Goldsmith, Mr Peter Bone, presented a Bill to apply the terms of the European Union Act 2011 such as to require approval by Act of Parliament and by referendum of provisions for creating a fiscal union or economic governance within the Eurozone.
	Bill read the First time; to be read a Second time on Friday 21 October, and to be printed (Bill 228).

Magna Carta Anniversary (Bank Holiday)

Motion for leave to bring in a Bill (Standing Order No. 23)

Eleanor Laing: I beg to move,
	That leave be given to bring in a Bill to designate Monday 15 June 2015 as a bank holiday in the United Kingdom to mark the 800th anniversary of the signing of Magna Carta; and for connected purposes.
	On 15 June 1215, the foundations of our democracy were laid when King John met his barons at Runnymede and sealed the historic document that has become known as Magna Carta. The effect of the Bill, which I now bring before the House, would be to celebrate appropriately the 800th anniversary of that momentous occasion. The concept of celebrating Magna Carta has widespread support. Indeed, Mr Speaker, we are grateful to you for having hosted in the Speaker’s House in June this year the inaugural meeting of the all-party parliamentary Magna Carta group, many of whose members are present this afternoon.
	What better way to celebrate freedom than by having a day’s holiday? I appreciate, of course, how difficult it is for businesses, service providers and schools to deal with the consequences of a day’s holiday, and I am not suggesting that 15 June should be an extra day’s holiday, but, given the current discussions about moving the May bank holiday, the perfect replacement for the first Monday in May would be 15 June: Magna Carta day.
	There is something unique and very special about celebrating Magna Carta. Its significance goes far beyond these shores. Upon it are based not only our own constitutional freedoms, but those of the United States of America, most of the Commonwealth and much of the European Union. Even in Scotland, where Magna Carta never had any force, its value as a constitutional document is still appreciated.
	The committee set up by the Magna Carta Trust, ably led by the inimitable Sir Robert Worcester, is proposing a Magna Carta day to the American Congress, to the Canadian, Australian, New Zealand, Trinidadian, Indian, South African and all Commonwealth Parliaments and to the legislatures of all countries that hold our values and suggesting that they observe the 800th anniversary and declare their Magna Carta day to share with ours.
	The German ambassador, when asked recently about the salience of Magna Carta, responded, “Magna Carta is known to everyone in Germany as the foundation of democracy—it is in the school syllabus.” What a pity it is not in our school syllabus.
	Winston Churchill was, of course, absolutely right, as ever, when said that Magna Carta was
	“the foundation of principles and systems of government of which neither King John nor his nobles dreamed.”
	Magna Carta established the very idea of the rule of law. It was the first formal document to insist that no one is above the law, however high his or her status. It also established that Executive power must proceed by recognised legal process, never unlawfully, when action is taken against an individual.
	In the 800 years since the principle of the rule of law was thus set down, every aspect of our country’s development has been influenced by it. This is not just dry, legal doctrine; it is our dependence on the belief in
	this fundamental freedom that has shaped our nation’s character, fostering belief and pride in our basic liberty and giving us the confidence to question authority. What began as an agreement to give people freedom from royal interference has developed over eight centuries into a range of fundamental liberties. Now it is not the monarch who tries to interfere in the lives of our people; it is the state.
	As we—Parliament—battle daily to keep the people we represent as free as possible from state interference, the principles of Magna Carta are every bit as important as they were 800 years ago. British people know that they have an inalienable right to freedom and to challenge the authority of Government. We have fought for that right through the ages—not only for ourselves, but for others right across the world.
	Looking at the events of the so-called Arab spring over the past few months, we see how much still has to be done in trying to win those precious rights for those who still do not have them. As President Obama said when he addressed our Parliament in May:
	“Centuries ago, when kings, emperors and warlords reigned over much of the world, it was the English who first spelled out the rights and liberties of man in the Magna Carta… through the struggles of slaves and immigrants, women and ethnic minorities, former colonies and persecuted religions, we have learned better than most that the longing for freedom and human dignity is not English or American or Western—it is universal, and it beats in every heart.”
	Magna Carta is a rare piece of legislation, perhaps unique, that has not just endured but evolved over the centuries. Although many of its provisions have been repealed, and rightly so, by later legislation, its principles none the less echo throughout the ages and across the globe today. Today, we need to rein in the power of an overbearing nanny state just as much as our forebears of the 13th century had to restrain the power of the king.
	I am not asking that we declare a bank holiday to mark the signing of some dusty old piece of 13th century paper or, indeed, the actions of an unpopular monarch some 800 years ago. We need a special holiday so that the British people can celebrate today’s freedoms on 15 June 2015—Magna Carta day. Our constitution, our civil liberties, our individual rights, the rule of law and the bedrock of our democracy are all too often taken for granted. However, we must never forget that the price of freedom is eternal vigilance, so let us cherish and appreciate our freedom, and let us celebrate it.
	I urge the House to support the Bill to give the people a holiday to celebrate Magna Carta and all that it still stands for.
	Question put and agreed  to .
	Ordered ,
	That Mrs Eleanor Laing, Mr Graham Allen, Helen Goodman, Robert Halfon, Oliver Heald, Mr Bernard Jenkin, Mr Peter Lilley, Mrs Anne Main, Stephen Metcalfe, Mr David Ruffley, Iain Stewart and Mr Jack Straw present the Bill.
	Mrs Eleanor Laing accordingly presented the Bill.
	Bill read the First time; to be read a Second time on Friday 25 November, and to be printed (Bill 227).

Health and Social Care (Re-committed) Bill
	 — 
	[2nd Allocated Day]

Further consideration of Bill, as amended in the Public Bill Committee

Clause 10
	 — 
	Duties of consortia as to commissioning certain health services

Nadine Dorries: I beg to move amendment 1,page6,line8, at end insert—
	‘(c) after paragraph (f) insert a new paragraph as follows—
	“(g) independent information, advice and counselling services for women requesting termination of pregnancy to the extent that the clinical commissioning group considers they will choose to use them.”.’.

Mr Speaker: With this it will be convenient to discuss the following:
	Amendment 2,page6,line8, at end insert—
	‘(2A) After subsection (1) insert a new subsection as follows—
	(1A) In this section, information, advice and counselling is independent where it is provided by either—
	(i) a private body that does not itself provide for the termination of pregnancies; or
	(ii) a statutory body.”.’.
	Amendment 1221,in clause 14, page9,line37, at end insert—
	‘( ) After paragraph 8 insert—
	“Provision of independent information, advice and counselling services for women requesting a termination of pregnancy
	8A (1) A local authority must make available to women requesting termination of pregnancy from any clinical commissioning group the option of receiving independent information, advice and counselling.
	(2) In this paragraph, information, advice and counselling are independent where they are provided by either—
	(a) a private body that does not itself refer, provide or have any financial interest in providing for the termination of pregnancies; or
	(b) a statutory body.’.
	Amendment 1252,page9,line37, at end insert—
	‘( ) After paragraph 8 insert—
	“Provision of advice relating to unplanned pregnancy
	8A The Secretary of State must ensure that all organisations offering information or advice in relation to unplanned pregnancy choices must follow current evidence-based guidance produced by a professional medical organisation specified by the Secretary of State.”.’.
	Amendment 1180,in clause 240, page226,line31, at end insert—
	‘(1) Regulations must require NICE to make recommendations with regard to the care of women seeking an induced termination of pregnancy, including the option of receiving independent information, advice and counselling about the procedure, its potential health implications and alternatives, including adoption.
	(2) The regulations must require health or social care bodies or any private body that provides for the termination of pregnancies to comply with the recommendations made by NICE under subsection (1).’.

Nadine Dorries: Four weeks ago I was not sure whether I would get to the point where I could speak in the Chamber today. This has been a long and hot-under-the-collar summer. Following my announcement of my intention to table the amendment, I have been threatened with being throttled, car-bombed, burned alive and a host of other distasteful and unpleasant ways in which I would meet my end.
	I shall not go into detail about any of these responses to my amendment. Needless to say, some of them involved bodily functions to a graphic degree, and some of the scatological messages were unbelievable. I will not repeat the bile that has poured into my inbox every day. I do not think there is anything that I or my staff could be threatened with, or that we could read or be told now, that would elicit any shock from us. There is nothing worse that we could hear.
	Before I go into the detail of the amendment, I shall talk about a significant and substantial shift as a result of the amendment. It has always been the tradition of the House that abortion issues have been discussed and debated in the Chamber and the media have commented on what happened, usually in a reasonable way. But the amendment has changed the game for ever. All Members in all parts of the House know, particularly from the 2008 debate, that we debate with passion. I would say that the 2008 debate was one of the best debates of the previous Parliament. However, we all remain courteous and friendly with each other following the debates. The usual parliamentary knock-about and the usual games take place—I shall say more about that in relation to the amendment in a moment—but the debate usually takes place here and the media comment on what happens here as it happens.
	I have no greater opponent in the House on this issue than the right hon. and learned Member for Camberwell and Peckham (Ms Harman). In 2008 she was the whipper-in and the mover behind what happened in that debate, but I have no greater respect for almost any other woman in the House than I do for her. I hugely respect what she has achieved for women and humanity, and I know that she approaches the issue honourably, as I hope I do. It is incredibly sad, therefore, that my summer has been made so difficult not by Opposition Members, who have all been incredibly quiet, but by the nastiness and the response of the left-wing media and union-funded organisations.
	The past four weeks have been incredibly difficult. The campaign against the amendment has been co-ordinated by an organisation known as Abortion Rights, which is funded by Unison and a number of other small unions. It also received membership contributions, but, as I was told in a meeting with the organisation, it is largely funded by the unions and Unison is the biggest contributor. [ Interruption. ] I am not saying that every penny is not accountable; I am just informing the House that the campaign has been funded by the unions. I do not think that there is a problem with that.

Emily Thornberry: Who funds yours?

Nadine Dorries: I will tell the hon. Lady exactly who funds my campaign—nobody. Neither I, nor my office has received a single penny. Here, to me, is the disadvantage of the amendment. The
	unions can contact Members’ constituents and ask them to e-mail individual MPs, but I cannot afford to promote the amendment in that way. The press barons, whom the unions have fed with their response to the amendment, can pour what they want into the newspapers, but I cannot. What we have seen is an absolute divide.

Luciana Berger: Will the hon. Lady give way?

Nadine Dorries: I will give way, because the hon. Lady has commented previously on the press in this regard.

Luciana Berger: Will the hon. Lady please tell the House exactly who funds the Right to Know e-mails that many of us have received in our constituency inboxes?

Nadine Dorries: I will answer that question, and after I do I hope the hon. Lady will tell me who funds Labour Friends of Israel. I have no idea who funds Right to Know, as I am sure Labour Members have no idea who funds a number of campaigns that support them.

Rachel Reeves: At what point will the hon. Lady move on to the substance of the amendment, rather than issues such as Israel and how Unison funds political campaigning?

Nadine Dorries: I absolutely will—that is why I am here—but it is important to explain the context and the background to some of misinformation that Members have received in their inboxes. This is my opportunity to correct the misinformation MPs have been fed about the amendment.
	The amendment has created a divide that was not present before, including in 2008. The Guardian and The Times and the union-funded Abortion Rights have mounted a campaign against the amendment. I must say that the core Conservative vote newspapers, The Daily Telegraph , the Daily Mail and so on, have been supportive, so this chasm and the politicisation of abortion has begun as a result of the amendment and as a result of the unions and the left-wing media.

Chris Bryant: Like The  Times?

Nadine Dorries: There are lots of comments being made from a sedentary position, Mr Speaker, but The Times has actually fed that divide directly and repeated much of the information it has been given. I want to answer some of the accusations made about me in response to the amendment. I do not have the press barons’ money to mount and fund a campaign. I have not received a penny. In fact, I am broke. My office has not received a penny in funding.

Lilian Greenwood: Will the hon. Lady give way?

Nadine Dorries: No.
	I have also been accused of being a religious fundamentalist. Like 73% of the country, I am a member of the Church of England and have Christian beliefs, but I am not sure when that became a crime and prevented me from having an opinion. On Saturday, The Guardian printed a flow chart showing the conservative Christians who are supposed to be mounting a sphere of influence with the amendment. I did not know who
	95% of the people mentioned were or the organisation they represent. If I followed Islam or Judaism, I wonder what the response would have been to such a flow chart in
	The Guardian
	. I found the chart absolutely reprehensible and disgusting.

Chris Bryant: Will the hon. Lady give way?

Nadine Dorries: I absolutely will not.
	I want to mention some of the other lies that have been printed about me. I have been accused of wanting to reduce the number of abortions by introducing the amendment. That is absolutely not the objective. However, if any individual in the street was asked about the amendment and told that it might bring down the number of abortions, would they say, “Well, that’s a good thing,” or would they say, “We’re proud of the fact that 200,000 abortions a year are performed in the UK”? That is the highest number in western Europe. Would the individual in the street say that that is a good thing? No, they would say that it probably would be a good idea if something could help to bring that number down. I do not want to restrict access to abortion. The amendment is not about restricting access. I do not want to return to the days of Vera Drake-style back-street abortionists. That is not what the amendment is about. I am pro-choice, although I am presented as pro-life in every newspaper. The pro-life organisations are in fact e-mailing pro-life MPs to tell them not to vote for the amendment. I am pro-choice. Abortion is here to stay.
	It is absolutely ridiculous that the amendment has been portrayed as something that would restrict access to abortion. The amendment is about medical practitioners making to a woman who presents at their surgery or organisation an offer of independent counselling, not compulsory counselling. Every single day I have read a headline stating that the amendment is intended to drive women into the arms of religious fundamentalists via compulsory counselling. That is absolutely not true. Any Member who rose and claimed that the amendment would make counselling compulsory would be being untruthful. It is nothing more than an offer. It is an offer made to some women who, when presenting at a GP’s practice, may have doubts, may be confused and may feel that they would like to accept. That is all it is—an offer. I find it very difficult to understand how anyone can object to a vulnerable woman being made an offer of counselling when she is suffering from a crisis pregnancy.

Jim Shannon: I thank the hon. Lady for giving way, and I commend her courage and perseverance. Does she share the concern of many in this House and outside about the businesslike and commercial decisions that are taken in relation to abortion and feel that, because one hour of counselling a week for everyone is not enough, it is wrong that a commercial industry has been made out of abortion? Does she agree that when abortion becomes a business, the feelings of people have been lost?

Nadine Dorries: The hon. Gentleman makes a pertinent point about the relationship between financial incentive and abortion counselling, which I will talk about in a moment to make it quite clear how the amendment relates to the issue.

Julian Huppert: Does the hon. Lady accept the comments of the Royal College of Obstetricians and Gynaecologists, which essentially says that there is not a problem? It has commented:
	“The system, as it stands, works well.”

Nadine Dorries: Well, that comment is probably the most fatuous we will hear in the debate, and probably the most disrespectful to women. I would like to know what the hon. Gentleman thinks about the report published last week in the British Journal of Psychiatry that women who have an abortion are twice as likely to suffer from mental health problems. Of course, I realise that the report he quotes from was probably written by men. I realise that the women who go through abortion and suffer as a result do not go back to the Royal College of Obstetricians and Gynaecologists to give feedback.

Julian Huppert: rose—

Nadine Dorries: I will not give way again to the hon. Gentleman, as I am sure that he will have an opportunity to make his point when he is called to speak later.

David Burrowes: My hon. Friend was right to introduce her remarks to the House and highlight the unacceptable personal attacks that have been made against her, which denigrate an issue of vital importance and interest to the whole House. The House needs to rise above that in today’s debate. With regard to evidence of change, could she indicate what research she has done on how much face-to-face counselling takes place in organisations such as the British Pregnancy Advisory Service, for example?

Nadine Dorries: I thank my hon. Friend, and in a moment I will come on to the difference between counselling and consultation, and what is available to women.
	Another piece of misinformation that has been put about is the idea that the amendment would prevent or delay the abortion process. Again, that is incredibly untrue. Counselling would be delivered within 24 to 48 hours, and the abortion process would take seven to 14 days to arrange. This amendment, this offer of counselling, is not for women who have made up their mind and—fantastic for them—want to go straight to the abortion clinic; it is for women who may be in distress. The counselling would be delivered within 24 to 48 hours, so there would be no delay whatever to the abortion process. In fact, many women who accepted the offer of counselling and proceeded to an abortion would proceed empowered, because they would have had the opportunity to talk through their situation with someone totally impartial—

Lyn Brown: rose—

Kate Green: rose—

Nadine Dorries: I want to finish this point, and then I will give way.
	The counsellor would be completely impartial, give no advice or direction and be entirely independent, so if the woman had been through the process and then continued to abortion, she would do so knowing that she had talked through her options with somebody.

Rachel Reeves: Will the hon. Lady give way?

Nadine Dorries: No, I have given way to the hon. Lady once. I will give way to the hon. Lady who also acts as a Whip.

Lyn Brown: I am listening with interest to the hon. Lady. How can she guarantee that the counselling that she proposes will not delay the abortion process?

Nadine Dorries: I have spoken to organisations that provide counselling and have 80,000 registered counsellors throughout the UK. [Hon. Members: “Who?”] The British Association for Counselling and Psychotherapy. I asked, “If somebody required counselling, was at a GP’s practice and a telephone call was made, how long would it take to get a counsellor to a particular woman?” The answer was that counselling could be delivered in the GP’s practice, at another venue or in the woman’s home, and that it could be anything from immediate to within 48 hours.
	Registered counsellors, who have e-mailed me regularly since the amendment was tabled, say that they would love to work—counselling is a growing industry—and to have the opportunity to work with women in that situation. Unfortunately, however, counselling is available on the NHS only via the abortion provider or via the hospital.

Mark Pritchard: I am grateful to my courageous and honourable Friend for giving way. As 147 babies were terminated after 24 weeks in the past year—a 29% increase on the previous year—does she agree that such counselling should also include the fact that many of those terminated babies, who had minor disabilities such as cleft lips, cleft palates, half an ear or having only one ear, could have been dealt with through modern cosmetic reconstructive surgery?

Nadine Dorries: I thank my hon. Friend for that comment. That is a different debate, but he highlights an important issue, and it is abhorrent that 147 babies were aborted for cleft palate, hare lip and minor cosmetic issues. I have a godson who had a club foot, and he was a wonderful young boy and is a wonderful young man. I find it quite amazing that anybody would choose to abort a baby because they had a club foot, but that is an issue for another day. The amendment does not cover it, but it is an important point.

Stewart Jackson: Does my hon. Friend share my incredulity at those Opposition Members who maintain that an organisation such as BPAS—the British Pregnancy Advisory Service—can be independent in its counselling, when in its March 2011 report and financial statement it notes that
	“an increase in procedures of 13 per cent against the background of falling national trends in 2010-11”
	is
	“a significant achievement”?
	How can the opponents of the amendment maintain that there is no fiscal link and no conflict of interest?

Nadine Dorries: That is a very important point, and in a moment I will come on to the financial link and the financial incentives, with some other information that we have.

Helen Grant: Will my brave hon. Friend confirm her belief that existing counselling services have the capacity to deal with the level of referral?

Nadine Dorries: That is precisely the next point in my speech; my hon. Friend must have been looking over my shoulder!
	I now turn to the counselling provision available to women today. Many women do not want or need counselling. They find out that they are pregnant and know exactly what they want to do, but those are frequently the women who are supported—who have partners, family and friends who will support them through that awful situation. No woman wants to have an abortion, but many know that they have to, for various reasons, and this amendment is not about them. A mystery shopper, however, recently approached several abortion clinics posing as a young woman who was pregnant and unsure of what to do. Every time I mention BPAS there is a howl from Opposition Members, but I am going to mention it in this instance, because this is irrefutable evidence.
	The individual posed at a central London clinic as a 26-year-old pregnant woman who did not know what to do, and she asked for counselling. I shall come on to the difference between counselling and consultation, but she said that she did not know what to do, because she had been given the immediate consultation, was not sure whether to go through with the pregnancy, and therefore wanted an abortion. She was told that, at that very busy clinic in central London, one hour of counselling was available at one set time per week. I believe that when she revealed her identity she was offered another hour.
	In fairness to BPAS, it says that it has flexibility in the system and can offer more hours. Why did it not do so? If it has flexibility, how much is there?

Chris Bryant: I am very grateful—[ Interruption. ] The hon. Lady says something from a sedentary position. I wholly deprecate the fact that she has had threats made, but it is inappropriate to bring forward this amendment to this Bill, because if we are going to consider abortion we should be considering the whole issue in the round, not just appending something to this kind of Bill. As she knows, I disagree with her, but she will also know also that the whole point of counselling, in any circumstance, is to allow a person to come to the right decision for themselves. That is precisely what BPAS, Marie Stopes and others provide, because any counsellor who does not do that is not worth their salt.

Nadine Dorries: I would love to hear how the hon. Gentleman knows that that is what happens in Marie Stopes and BPAS. He always speaks on such issues as someone with huge experience, but I am highlighting at this moment what happens. If he thinks that one hour per week, at a set time at a busy London clinic, for the entire throughput of women having abortions, is enough counselling, so be it; that is his opinion.

Fiona Mactaggart: rose—

Chuka Umunna: rose—

Nadine Dorries: I should like to make this point before I take any more interventions, because I also want to defend BPAS. I do not want it to look as if I am attacking the organisation, because it, and probably more so, Marie Stopes, do what they do—the clinical procedure of carrying out abortion—incredibly well. The service that they provide for the NHS is absolutely vital, and I do not want to see Marie Stopes or BPAS disappear or to diminish their roles. They have a job to do, and they do it well. Their job is the provision of clinical abortions, and I want that to continue.

Louise Mensch: Will my hon. Friend confirm that it is still safe for those of us who do not have concerns about the counselling that BPAS and Marie Stopes offer to support her amendment, because it does not prevent BPAS and Marie Stopes from offering counselling? I, for one, have no such concerns, yet I am prepared to vote for her amendment, because it does not prevent those organisations from offering advice. Will she confirm that?

Nadine Dorries: My hon. Friend is not totally correct, because the whole purpose of the amendment is to separate out the financial situation. I shall come on to that in a moment. I disagree with my hon. Friend, and if she listens to the rest of the debate she will understand why. I do not believe that the place where an abortion was carried out is the right place for someone suffering from post-abortion distress to receive their counselling—a situation that many women suffering from post-abortion distress have told me about.

Andrew Selous: I am grateful to my hon. Friend and parliamentary neighbour. May I for a second take the debate from the general to the particular? I think that she is on to something. I mentioned a 23-year-old constituent of mine who, having been to an abortion clinic, then went to a clinic such as my hon. Friend advocates. It was then her decision: she decided to change her mind, and today has a beautiful three-month-old daughter. She is pleased that she had the opportunity for that counselling, which no one forced her to take. That is why I think my hon. Friend is on to something.

Nadine Dorries: I hope that my hon. Friend is talking about the Crisis pregnancy centre in Dunstable, which I have visited along with many others. It does amazing work with young women.

Craig Whittaker: Marie Stopes International said in the briefing that it sent to all MPs that only 2% to 2.5% of women who go through the abortion counselling process opt to keep the child. Does my hon. Friend agree that that may indicate an incredibly poor success rate among counselling services?

Nadine Dorries: I thank my hon. Friend for that intervention, because I am coming to another interesting statistic that I have not yet included in my speech.

Gavin Shuker: rose—

Nadine Dorries: I will give way in a minute.
	There is a huge disparity between the figures that show both where a woman received her counselling and her decision. In 2008, BPAS announced that the proportion of women who came to it and decided not to proceed with an abortion was as high as 20%. Unfortunately, freedom of information requests asking for the figures and the contracts with PCTs show that that is not true: the real figure is 8%, and sometimes even lower in some PCTs. I am not sure why an abortion organisation would say that its figures for women who do not proceed to an abortion are higher than they actually are.

Gavin Shuker: rose—

Kate Green: rose—

Nadine Dorries: I want to finish this point, and then I will give way. I know that the hon. Member for Stretford and Urmston (Kate Green) wants to intervene, and I will take an intervention from the hon. Member for Luton South (Gavin Shuker) first, in a moment.
	There is a huge disparity in the figures, and the freedom of information request shows an even bigger disparity. Marie Stopes had told me—I hope I get this right—that the proportion of women who go to the organisation and do not proceed to termination is about 15%, although I do not know what freedom of information requests would show about those figures. The fact is that abortion providers are saying that 20% or 15% of women do not proceed to abortion, although freedom of information requests show that the figure is 8%, as was shown in the press this week. I have no idea why there is that disparity, or why they would say that the figure is 20% when it is not.

Several hon. Members: rose —

Nadine Dorries: I give way to the hon. Member for Luton South.

Gavin Shuker: The hon. Lady has rightly probed the relationship between counselling and abortion on behalf of those of us who feel uncomfortable about that relationship. However, does she agree that 90 minutes does not seem like a long time for us to debate the implications of what is going on? The Bill is substantively about the nature of the NHS, and not about abortion provision. In that light, I urge her to consider whether it is appropriate to divide the House on this issue.

Nadine Dorries: I do feel that it is appropriate to divide the House on this issue, because I would like the amendment to be part of the Bill.

Several hon. Members: rose —

Nadine Dorries: I am not going to take any interventions for a few minutes. I would like to go back to the fact that only one hour of counselling is available in a busy London clinic. I ask Members, just for a moment, to put themselves in the shoes of a 16-year-old girl who turns up at that clinic and does not know what to do. She is pregnant and panicking. Some of her friends tell her to have an abortion and some tell her not to. She does not want to tell her parents because she is scared of doing so. Her boyfriend is saying to her, “You’ve got to have an abortion and get rid of it.” That is a mish-mash of the four or five stories a day that we hear in my office.
	The girl starts vomiting in the morning and carries on all day. She feels sick and ill and cannot think straight. She is not sleeping because she is scared stiff. She has not gone to school for more than a week because she thinks that people there will be able to tell that she is pregnant. She is out of her mind with worry. She turns up at a clinic and is told, “Sorry, that one appointment’s been taken. You’ll have to go to Richmond.” The girl does not even know where Richmond is, and she has never even been to hospital without having her mum with her.
	I would like hon. Members to think about what it is like for that 16-year-old girl, and what they have against a GP or somebody else offering that girl an hour’s counselling so that she can talk through the issues and reach the right conclusion for her, non-advised.

Several hon. Members: rose —

Nadine Dorries: I know that others want to speak. I have been speaking for a while and I want to get to the end, so I will keep going for a bit longer. I will take interventions in a minute. [Interruption.]

Mark Pritchard: Soubry, zip it! [Interruption.] Sorry, Mr Speaker.

Mr Speaker: Order. The hon. Gentleman should withdraw that remark.

Mark Pritchard: I withdraw it, Mr Speaker.

Mr Speaker: I am grateful to the hon. Gentleman. Let us try to maintain proceedings on an even keel. The hon. Gentleman has said that he is sorry, and that is fine.

Nadine Dorries: As I said, I do not want to look as if I am knocking abortion providers. As a nurse, I assisted with many terminations. I do not want to look as if I feel that there is no place for abortion provision. I am pro-choice and do not want to return to those other days.

Jim Shannon: rose—

Chuka Umunna: rose—

Nadine Dorries: I give way.

Jim Shannon: rose—

Chuka Umunna: rose—

Mr Speaker: Order. It is important that the hon. Lady makes it clear to whom she is giving way.

Nadine Dorries: I give way to the hon. Member for Streatham (Mr Umunna).

Chuka Umunna: The central point of disagreement for many people is the implication in the amendment that the abortion providers—BPAS has presence in my constituency—are incapable of providing impartial independent counselling to those who come to them.
	The manager and staff at the centre in my constituency have said that they find insulting the idea that when they are giving counselling they are somehow seeking to persuade those who come to them to have an abortion, when that is not the case. In fact, when I visited BPAS recently a couple of young ladies had come to the centre intending to go through with an abortion but subsequently decided not to because of the counselling that they received.

Nadine Dorries: All I can say is that we will look at the freedom of information figures that have come from the clinic in the hon. Gentleman’s constituency. If what he says is the case, that must have been the year’s allocation for that clinic, because the FOI request information that we have received does not show that.

Several hon. Members: rose —

Nadine Dorries: No, I will carry on for a bit longer.
	I want to talk about the difference between consultation and counselling. I doubt very much whether the constituents of the hon. Member for Streatham had counselling; I think they probably had consultation. There is a big difference. Every woman who turns up at an abortion clinic has a consultation, but that is about the medical process—the side effects and what is going to happen. Every e-mail that we receive from women on this subject involves a consultation. This is how the law stands today; my hon. Friend the Member for Broxtowe (Anna Soubry) might want to listen to this, as most of the way through she has been nodding in agreement with the adverse comments.
	When a woman turns up at an abortion clinic, the clinic does not offer counselling. It does offer consultation, but the woman has to ask for counselling; it is not offered. She has to ask—or the doctor in the clinic has to see that a woman is in a particular position, or be alarmed enough by her state to offer counselling. I want to make the point very clear: counselling is not offered, but has to be asked for. [Interruption.] Someonesays from a sedentary position that it is, but if it is, the centre is operating outside the guidelines, because counselling is not offered.

Edward Leigh: I am sure that many abortion providers do their level best to give advice, but that is not the point being made. Surely in any field of endeavour it is not appropriate for the provider of a service to give the so-called independent advice. That is the key point—and, frankly, the only point.

Nadine Dorries: As I have said to many people, I will come on to the financial situation and the reasons for it.
	To recap, the amendment proposes that abortion clinics make an offer of counselling, which they do not make because under the guidelines they have no provision to make it—the woman has to ask for it.
	Last week, The British Journal of Psychiatry reported that women who abort are twice as likely to suffer from mental health problems.

Julian Huppert: Will the hon. Lady give way on that point?

Nadine Dorries: No.
	I do not want to ban abortion—I want it to continue—but should we not be taking better care of our young girls and women? Should we not be offering them something better? How do women get to the position of suffering mental health problems as a result of abortion?

Jim Shannon: The hon. Lady will be aware of facts and figures that indicate that a number of people who have had abortions regret it afterwards. Does she feel that if the consultation process is done correctly and the information is shown to the person who wishes to have the abortion, they would perhaps then decide that the child they are carrying could develop into a young lady and have life? Does she feel that the consultation process is clearly where the issue has to be addressed and that the emphasis has to be on the counselling, not on the abortion?

Nadine Dorries: The hon. Gentleman makes a point that is pertinent to his own beliefs. What I believe about counselling is that no advice should be given, that there should be no direction, and that it should be completely impartial. It should be an influence-free zone—a bubble—where a woman can sit and talk through the issues with somebody who is not guiding her. That is what counselling should be.
	Every single day I receive e-mails from women who do not want other women to experience what they have experienced—who do not want their daughters to go through what they have gone through. I receive e-mails from staff who are working in, or have worked in, abortion clinics. I am in dialogue with some very senior members of staff of a number of organisations and abortion clinics across the UK—

Luciana Berger: Will the hon. Lady give way?

Nadine Dorries: No, I will not give way again.
	Those members of staff are themselves not necessarily happy with the guidelines and the way in which they are forced to operate. I speak to people at abortion clinics across the UK who would like the guidelines to change because they do not necessarily feel that women receive the counselling that they should receive because it is not offered but has to be asked for.

Kate Green: rose —

Nadine Dorries: I give way to the hon. Lady, who has tried to intervene several times.

Kate Green: Where in the hon. Lady’s amendment is there a guarantee of the quality of counselling that women would receive from such organisations?

Nadine Dorries: I hope that the quality of counselling is determined by the professional bodies by which the counsellor is accredited—they determine the standard of counselling. It does not matter whether counselling is for an abortion, for cosmetic surgery, or for anything else—it has a defined manner in which it is delivered, which is that advice is not given, that influence is not asserted, and that it is totally impartial. Any counsellor who is trained as such and accredited by a professional body delivers counselling in that manner.
	Let me return to the mental health issue and the e-mails that I receive on a daily basis. One of the problems—

Sarah Wollaston: Will my hon. Friend give way?

Nadine Dorries: No, I should like to continue. [Hon. Members: “Give way!”] I will give way once more and then not until I have finished the next section.

Sarah Wollaston: My hon. Friend has twice quoted the Royal College of Psychiatrists and asserted that there is a much higher rate of mental illness after termination of pregnancy, but the RCP has made it clear—any Member can look online at the draft of its very comprehensive evidence review—that we have to compare like with like. In other words, we have to make a comparison with rates of mental illness after unwanted pregnancy. Looking at the rates after unwanted pregnancy, we see that there is no difference between the rate of mental illness after termination of pregnancy and live birth. Indeed, the biggest predictor of mental ill health after a termination of pregnancy is whether somebody was suffering with problems beforehand.

Nadine Dorries: The hon. Lady makes the assumption that I want women to continue with unwanted pregnancies. That is not the case. I have made the point that abortion is here to stay for any woman who wants an abortion. The amendment simply proposes that any woman who feels that she wants or needs counselling can be offered it—that is all. I find it very difficult to understand why the hon. Lady would feel that anybody in a crisis pregnancy should not be offered counselling. Why should they not?

Stewart Jackson: The hon. Member for Cambridge (Dr Huppert), who is currently fulfilling his role as Dr Evan Harris’s vicar on earth, expressed the view that everything is fine at the moment. Does my hon. Friend share my concern that it is routine for primary care trusts absolutely to refuse to reveal the financial relationship they have—for instance, with Marie Stopes or BPAS—on the basis of commercial confidence, and that it takes freedom of information requests to get that information? The system is clearly not working, and if we want transparency and openness, things have to change.

Nadine Dorries: My hon. Friend is absolutely right. Not only that, but the accounts of BPAS and Marie Stopes, which are revealed via the Charity Commission, can sometimes be three years out of date—we do not get to see them until three years later. That is amazing when one considers that the Charity Commission is paid £60 million of taxpayers’ money each year.
	This, for me, is about the women who have contacted me and asked me to propose this amendment on their behalf, and I have to dedicate some of this speech to them. Every day I receive e-mails and speak to people—

Luciana Berger: Will the hon. Lady give way on that point?

Nadine Dorries: No.
	I constantly speak to people at a high level across the abortion industry, and they always tell me that no woman goes through those doors wanting to be there. All women’s stories are the same; there is a theme that runs through every single one. The individual circumstances may be different, but the stories all start in the same way and with the same questions: “Will I lose my job or
	won’t I lose my job?”; “Will he leave me or won’t he leave me?”; “Will my parents kick me out or won’t they kick me out?” The questions are all the same; there are no surprises. Many women say that once they are referred—

William McCrea: Perhaps this is not about this particular debate on the amendment, but I have to say that some of us in this House have the conviction that the emphasis seems to be on the right of the woman and that it is about time we spoke about the right of the unborn child. They have rights too.

Nadine Dorries: The hon. Gentleman is a man of great conviction and, I think, a lay preacher, and we all respect and honour his views. However, the amendment is not about the unborn child; it is about the woman accessing counselling.

Margaret Hodge: Will the hon. Lady give way?

Nadine Dorries: No, I want to continue for a bit longer.
	The diagnosis of pregnancy happens very quickly. One can buy a pregnancy testing kit for £1. It is possible that the reason some women suffer distress following an abortion is that they can be tested before they have even missed their first period. For some women, that is fantastic and they go straight for an abortion when they find out. For others, however, it all happens so quickly that they can be aborted by the time they are seven or eight weeks pregnant, and then afterwards, when the pressure has gone and the coercion has disappeared, they realise—

Phillip Lee: Will my hon. Friend give way?

Nadine Dorries: May I just finish this point? When those women would have been 10 weeks pregnant, two or three weeks after the abortion, they realise that they could have worked it out and that they could have got there somehow. That is when the problems are beginning to kick in. That is why an increasing number of women are becoming very anxious about the fact that they do not receive pre-abortion counselling. That is why I receive so many e-mails and why other organisations receive them.

Phillip Lee: I want to place it on the record that as somebody who wants a reduction in the time limit on abortions provided in this country; who wants independent counselling to be provided; who has seen many patients who have had mental health problems post-abortion, such as self-harming and depression over 10 years; and who has been present at a termination and watched an eye go past in a tube, with a cursory reference made to it by the consultant, unfortunately I am frustrated by the way in which the amendment has been tabled. The hon. Member for Rhondda (Chris Bryant) made the point that abortion as an issue should be talked about in the round. As a consequence, I cannot support the amendment, but that does not mean that I do not support the principles and the desire to make abortion as infrequent in our society as possible.

Nadine Dorries: I thank my hon. Friend for his candour. However, I inform him that opportunities to debate abortion in this House do not come very often. In fact, the last time it happened was in 2008 when I had to table an amendment to another Bill, which was controversial. The same criticism was made that the amendment should not have been tabled to that Bill. The fact is that the Government do not make provision for abortion to be discussed in this House. Therefore, it either has to be attached to a Bill like this or it does not happen at all, unless one is drawn first in the ballot for private Members’ Bills.

Phillip Lee: Yes, but my point is that this is such an emotive subject—we can tell from the responses on both sides of the House that people feel passionately about this—that the debate needs to be calm and considered and the language both here and in the media must not be inflammatory or incendiary, because if it is, it polarises the debate and those of us who want to see progress towards abortion not being so prevalent in society get terribly frustrated.

Nadine Dorries: Well, I hope that the unions and the left-wing media will take my hon. Friend’s comments on board.

Andrew Selous: I wonder whether my hon. Friend will clarify something. It is my understanding that if she chooses to press any of her amendments to the vote, it will be amendment 1221. I wonder if that might be more acceptable to my hon. Friend the Member for Bracknell (Dr Lee) than amendment 1, which he may have been speaking about.

Nadine Dorries: The amendments are grouped, but when I spoke to the Table Office last night, I was told that I would speak to amendment 1 and that amendment 1 would be pressed to the vote. I hope that the Clerks will clarify that. [ Interruption. ] I will take advice from the Clerks, but when I spoke to the Clerk last night, I was told that it was amendment 1. [ Interruption. ] My hon. Friend the Member for South West Bedfordshire (Andrew Selous) is going to find out for me now.
	On the offer, the amendment would provide space and time to talk and think for women who are feeling confused—that is all.
	I now come to the financial arrangements between abortion clinics and counselling providers. If anybody in this House were to take out a mortgage today, the person who sold them the mortgage would have to refer them elsewhere for independent advice. If it was a husband and a wife, I believe that they would have to go to separate advisers, because they cannot both take advice about taking out the mortgage from the same person. I wonder why we feel it is appropriate that organisations that take £60 million a year of taxpayers’ money and are paid to carry out abortions give advice on the procedure.

Penny Mordaunt: I am a former director of the largest patient organisation in Europe, which provides services on the commissioning side and the provider side through advice and support. It is a charity that deals with long-term conditions. We had to follow extremely strict rules to ensure that there was no conflict of interests and we could not provide commissioning services to an area of the country if we
	were also on the provider side. Why does she think that that situation has not existed for this particular area of health care?

Nadine Dorries: Because, unfortunately, abortion provision and counselling is never scrutinised thoroughly or legislated on. No legislation happens in this place to deal with abortion. It is an issue that can never be debated. People shy away from debating abortion because of the uproar that results so things do not happen that perhaps should happen. If one is to have cosmetic surgery and it is deemed that it might have a psychological effect, one would be offered independent counselling. That does not happen with abortion.

Chuka Umunna: Will the hon. Lady give way?

Nadine Dorries: No, I would like to continue on the financial incentives.
	BPAS and other organisations would say that they do not have to meet targets and that they have no financial concerns. However, BPAS has advertised for business development managers, whose primary function is to increase its market share—those are its own words in the advert. If an organisation advertises that it wants to increase the number of abortions, can we trust it to provide vulnerable women who walk through the door with the counselling that they need? On pensions mis-selling, this place has separated by law the people who provide and sell pensions from the people who advise on pensions.

Frank Field: Does the hon. Lady accept that she might further her case if she concluded her contribution soon?

Nadine Dorries: Sorry?

Frank Field: My advice was that the hon. Lady might further her case if she concluded her remarks shortly.

Nadine Dorries: Yes, I will.
	I will come to a conclusion now, as time is whizzing away because of the interventions. I thought long and hard before tabling this amendment. Like so many issues—

Angie Bray: Will my hon. Friend give way?

Nadine Dorries: No, I am going to close. I thought long and hard about tabling this amendment. Like so many issues concerning abortion, it is a highly emotive area. There are those who believe that the right to an abortion is so sacred that, no matter what, it should never be touched, debated or reformed. There is not a single MP in this House who has not been asked by a constituent about their beliefs on this issue. I am sure that many prefer, understandably, to fudge a response, particularly when the reaction to discussing abortion can be so aggressive, as I have found to my cost.
	The amendment is about one thing and one thing only: providing women with more choice. It would allow women who are at their most vulnerable greater access to support. It must be wrong that the abortion provider that is paid £60 million to carry out terminations also provides the counselling when a woman feels strong
	or brave enough to ask for it. If an organisation is paid that much for abortions, where is the incentive to reduce them?
	I will move on to the tactics that have been used in this House to thwart the amendment. I wish to be very clear and will take no more interventions. I went to see the Prime Minister regarding this amendment and he was very encouraging. In fact, it was at the Prime Minister’s insistence that I inserted the word “independent”. I have attended a meeting at the Department of Health at which it was decided what process would be implemented to make this a reality.
	Last weekend, the former MP for Oxford West and Abingdon, Evan Harris, who has spent most of the day in the office of the hon. Member for Cambridge (Dr Huppert)—he is still here, tabling his amendments—turned up on the airwaves expounding the theory that there is no evidence of a problem, that the amendment is unnecessary as nothing needs to be fixed, that the status quo should remain and that the abortion industry should be allowed to continue under the veil of secrecy that it has.
	I received a message informing me that the former Member for Oxford West and Abingdon had approached the Deputy Prime Minister’s office and exerted pressure. In fact, he tweeted exactly that, saying that he had applied pressure on the Deputy Prime Minister, who had now forced the Prime Minister to make a climbdown. Basically, a Liberal Democrat—in fact, a former MP who lost his seat in this place—is blackmailing our Prime Minister and our Government. Our Prime Minister is being put in an impossible position regarding this amendment. Our health Bill has been held to ransom by a former Liberal Democrat MP, who has focused on this amendment.
	The interesting thing is that ComRes polling shows that 78% of the public support the amendment.

Martin Horwood: On a point of order, Mr Speaker.

Simon Hughes: rose —

Nadine Dorries: I will not give way. The right hon. Gentleman may be interested to know—

Mr Speaker: Order. I apologise for interrupting the hon. Lady, but there is so much noise in the House that it is sometimes difficult to know whether somebody is seeking to intervene or standing for another purpose. Point of order, Mr Martin Horwood.

Martin Horwood: On a point of order, Mr Speaker. Is it in order for an hon. Member to accuse a former hon. Member of blackmail in the course of their speech? That is an accusation of a criminal offence.

Mr Speaker: I am grateful to the hon. Gentleman. My understanding at present is that there has been no breach of order. However, I would say to the hon. Member for Mid Bedfordshire (Nadine Dorries) and to the House that temperate language, moderation and good humour are the essential features referred to in “Erskine May”, and it is best if they inform our debates.

Nadine Dorries: Thank you, Mr Speaker.
	I think our Prime Minister has been put in an impossible position. I want every Liberal Democrat Member to know that in the polling that was done, support for the amendment was 78% among the public, but it was highest among those who voted Liberal Democrat in the 2010 election, at 84%.

Julian Huppert: Will the hon. Lady give way?

Nadine Dorries: No, no, no.
	I think that is because Liberal Democrats traditionally support choice. Is it any wonder that the person in question is now the former Member for Oxford West and Abingdon?

Andrew Percy: Will my hon. Friend give way?

Nadine Dorries: It is time to make a decision not informed by the Liberal Democrats, and without being blackmailed by a Liberal Democrat or held to ransom by the Liberal Democrats. It is time to make a decision based on our conscience. I say to hon. Members: be prepared to stand by your view today for a long time, as it will be on everyone’s parliamentary record. In weighing up whether to support the amendment, Members should bear in mind the fact that 78% of the public support it. This is why we are here as Members of Parliament—to make difficult decisions such as this, not to be blackmailed or held to ransom. This is why we are MPs—because our constituents expect us to be brave. They expect us to stand up in the face of blackmail and be accountable.

Andrew Percy: Will my hon. Friend give way?

Nadine Dorries: It does not happen very often in the House, but we have a conscience vote. It hardly ever happens, but we are all personally answerable for the decisions that we take. This decision is about nothing more than supporting an offer of counselling to vulnerable women who may need it and who may use it as a lifeline.

Andrew Percy: Will my hon. Friend give way?

Nadine Dorries: How many times do I have to say no to my hon. Friend?
	This is about being accountable for our views, which is what Parliament is all about. I do not see why we should shy away from putting our positions on the record. If Members want to stand in the way of a woman’s basic right to independent counselling, then they should vote against this proposal. However, if they want to ensure that a woman can have access to very basic support, they should vote for the amendment. It is up to them—support these reasonable measures to provide all women with independent counselling, or stand in the way of that basic support.
	This vote is about women. I want every woman in this country to be able to look every MP in the eye and ask, “How did you vote for me and my daughters? What was the decision that you took?” Every MP will be accountable for that vote and that decision today.

Diane Abbott: The decision to seek an abortion may be the most serious and difficult that many women face in their lives, and I think it deserves some seriousness and calm in this debate.
	For nearly five decades, this House has been in agreement that abortion and matters related to it should be above mere party and partisan politics. For nearly five decades, there has been a settled pro-choice majority in this House and in the country, and for nearly five decades the House has believed that when Members of all parties have religious or ethical objections to abortion, their right to vote against it should be absolutely respected. However, this amendment is not about that. It is a shoddy, ill-conceived attempt to promote non-facts to make a non-case.

Several hon. Members: rose —

Diane Abbott: I am afraid that we are an hour into an hour-and-a-half debate, and I am anxious to allow time for other Members to speak.
	The case that the amendment is intended to make is that tens of thousands of women every year are either not getting counselling that they request, or are getting counselling that is so poor that only new legislation can remedy the situation. I might say, after many years in the House, that in matters of this kind, if legislation is the answer we have almost certainly asked the wrong question.
	The amendment is the opposite of evidence-based policy making. We know that the British Medical Association advises its members:
	“A decision to terminate a pregnancy is never an easy one. In making these decisions, patients and doctors should ensure that the decision is supported by appropriate information and counselling about the options and implications.”
	We know that the Royal College of Obstetricians and Gynaecologists guidance on abortion states:
	“Women should be given counselling according to their need—including post-abortion if she needs it. All women should be offered standalone counselling. The counselling should include: implications counselling (aims to enable the person concerned to understand the…course of action…); support counselling (aims to give emotional support in times of particular stress) and therapeutic counselling (aims to help people with the consequences of their decision and to help them resolve problems which may arise as a result)”.
	We know that Department of Health regulations state:
	“Counselling must be offered to women who request or appear to need help in deciding on the management of the pregnancy or who are having difficulty in coping emotionally”.
	We also know that all the clinics that have been discussed in the debate are inspected and regulated.
	Yet the proposers of the amendment are asking us to believe, on the basis of purely anecdotal evidence, that tens of thousands of doctors, nurses and charity workers involved in the 190,000 abortions a year are wilfully ignoring both the law and the guidance of the British Medical Association and the Royal Colleges. They go further than that, arguing that tens of thousands of doctors, nurses and charity workers are merely in it for the money. They imply that those men and women are involved in some sort of grotesque piecework. It is almost as though they were paid per abortion. The
	proposers of the amendment, I might add, also seem to be arguing that thousands of women do not actually know what they are doing. It tells us something about the validity of their claims that they are obliged to smear tens of thousands of doctors and nurses to make any kind of case. No wonder that a journalist for
	 The Sunday Times
	—no friend of the liberal left, but one who happens to have served as a lay member of the Royal College of Obstetricians and Gynaecologists—last weekend described the amendments as a “senseless and sinister bid” to cut abortions.

Kevin Barron: I agree with my hon. Friend. Any evidence that we have heard has been anecdotal—we have heard of a 16-year-old’s journey and of e-mails that hon. Members have seen but that I have not. However, my hon. Friend makes a real point. The conclusion of the consultation might be that a termination takes place, but this is the only procedure in this country that requires the informed consent of two doctors. Government Members besmirch doctors by saying that such things happen daily, but that is not true. From my nine years on the General Medical Council, I recognise that we have good ethical guidelines for doctors. Nothing is done without the informed consent of two medical practitioners.

Diane Abbott: My right hon. Friend makes an excellent point.

Several hon. Members: rose —

Diane Abbott: I would be more willing to give way were we not so far advanced in a debate that will last for only an hour and a half. I was not aware that so many Back Benchers wanted to contribute, because they have not hitherto tried to intervene.
	Some colleagues have expressed their surprise that yet again we are discussing women’s reproductive rights in this House, but they should not be surprised. Abortion has never stood on its own as a technical issue; it is part of a century-long debate about women’s sexuality, womens’s rights and women’s freedoms. Sadly, for some people that is apparently still contested ground in 2011. Some even argue that the proposals are best seen as part of a wider push on the socially conservative agenda that has been so successful for right-wing politicians in America. Thankfully, in this country, that agenda has come up against a determination to keep such issues above party politics, the absence of a Fox News pumping out socially conservative propaganda 24 hours a day and British common sense.
	I could say many things on the lack of an evidence base behind the amendments, but let me say this: women—both individual women and women in general—have been called in aid in this debate, and indeed they face very real problems in this society, here in 2011. They face spiralling unemployment as a direct consequence of the coalition’s policies and the sexualisation of our culture, which affects younger and younger female children—[ Interruption. ] I hope that hon. Members listen to this, because it is a point that many mothers and fathers will understand. Too many young women in communities up and down the country think that the only road to fame and fortune is to pump their bottom and their breasts full of silicone and tout themselves as
	some sort of media celebrity. Another issue is the number of very young women who have been badly parented, who have children too young and who, with all their good intentions, parent their own children badly in turn. Even in an era of financial constraint, those are the issues that this House should be addressing.
	Nobody is saying that arrangements in relation to counselling cannot be improved. I believe that the hon. Member for Cambridge (Dr Huppert) has tabled a good amendment to that effect, which some of us hope finds favour in another place. However, the Bill and the amendment are not appropriate for a full and careful debate on abortion. The amendments deal with matters that are amply covered by existing law and regulations.

Mark Pritchard: rose—

Daniel Poulter: rose—

Diane Abbott: I shall give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

Daniel Poulter: The hon. Lady is making an excellent speech and has outlined the fact that there is adequate provision for counselling in the status quo. Doctors, nurses and other medical professionals who must deal with such situations every day have adequate measures in place, as the Royal College of Obstetricians and Gynaecologists has outlined. They do not look only at the medical consultation, but at the whole patient, as we have heard. If that means that counselling is required, they will ensure that their patient gets it. Does she agree that this is not the place for the amendment, which serves no purpose, and that we need to get on and debate the Bill?

Diane Abbott: I am grateful to the hon. Gentleman, who is, of course, a practising doctor who knows a great deal more about these matters than many of us in the House.
	As hon. Members have heard, the amendments deal with matters that are amply covered by existing law and regulations that are well known to doctors and nurses. They deal with matters that must, at the end of the day, be between a woman and a doctor. I deprecate the extent to which amendment 1 is an attempt to import American sensationalism, confrontation and politicisation into these issues in a way that will be of no benefit to ordinary women.
	There is no evidence base for the amendments, and on the basis of all the recent polls there is no substantive support for amendments of this nature. Legislation addressing the issues raised by Government Members is already in place. This House should have more respect for the medical profession and for the vulnerable women who put themselves forward for abortion in one of the most difficult periods in their lives, rather than support an amendment of this nature, which is spurious and baseless. I urge the House emphatically to reject the amendment.

Anne Milton: I feel that I need to start by saying that this debate is about women; it is not about hon. Members. It is about ensuring that women get the very best possible services that they not only need but deserve.
	There was much comment and speculation ahead of the debate, not all of it accurate or helpful. It might therefore be useful if I explain the Government’s approach to meeting the spirit of the amendments without primary legislation. I associate myself with my hon. Friend the Member for Bracknell (Dr Lee), who urged calm and balance. Today’s debate has not necessarily reflected either of those things.
	How do the Government intend to meet the spirit of the amendments?

Kate Green: Will the Minister give way?

Anne Milton: I need to make a little progress.
	The Bill gives new public health functions to local government. In some cases, the steps that local authorities must take will be prescribed in regulations, which include the provision of sexual health services and abortion services. That will be a duty of local authorities and not of clinical commissioning groups—some of the amendments in the group have caused confusion about that. We intend to specify in regulations that local authorities must ensure that part of what they commission is a choice of independent counselling.
	Amendments 1 and 2 would fragment the service by splitting responsibility for the commissioning of counselling and for the commissioning of the rest of the service. If they and amendment 1221 were to be made, clinical commissioning groups and local authorities would have different but overlapping duties in relation to independent counselling, and the definition of “independent” would be different for each. We would have a fragmented service, which none of us wants. Most women go to their GP, which is not the same as a clinical commissioning group, or they self-refer to an abortion provider, so amendment 1221 would not work.
	None the less, the amendments have highlighted some important issues. There are indeed no quality standards for abortion counselling, and women are not always offered the opportunity to have counselling. It is worth repeating that we want counselling to be provided by appropriately qualified people who offer non-judgmental, therapeutic support, and who act according to their professional judgment, in the best interests of their clients, without undue influence or regard to outside interests.
	I know there has been considerable interest in exactly what “independent” should mean and in whether it must automatically mean independence from the abortion service provider in every possible way. That is not a simple question, and it is certainly not as simple a question as the amendments imply. There are permutations of financial, organisational and clinical independence to be considered. For example, would the amendments mean that a self-employed counsellor who had a contract with a charitable abortion provider for two days a week was independent on the other three days, or not?
	Before we legislate, we want to think through all the implications—including financial and legal—of a definition. We also want to consult widely and publicly as part of our proposals to help us ensure that we really improve services for women at what we all know is an extremely difficult time in their lives. We need to consult the public; indeed, we need to consult the women about
	whom we are talking. We have heard passionate contributions this afternoon, and I want to harness and corral them to create the calm and balance that we all want to be established, so that we can consult and arrive at the best conclusions. I also stress that the regulations would be subject to affirmative resolution.
	Whether women want to take up the offer of independent counselling will be a matter for them, but we are clear that the offer should be made. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) mentioned the post-abortion period. That is a critical time on which there is little focus.

Chris Bryant: Will the Minister give way?

Anne Milton: I am afraid that time is against me.
	I hope that what I have said reassures my hon. Friend the Member for Cambridge (Dr Huppert), who I believe is trying to be helpful, but we do not support any of the amendments. We intend to ensure that the independent counselling offered to women follows the highest standards of good practice. My hon. Friend’s amendment 1252 is therefore unnecessary, as well as, we believe, unenforceable as currently drafted. It does not define “information or advice”, and crucially, it does not mention independent counselling. Counselling is different from advice and support. However, the Government support the spirit of the amendments, and we intend to present proposals for regulations after consultation. Not only is primary legislation unnecessary, but it would deprive Parliament of the opportunity to consider the detail of how the service will develop and evolve.
	Amendment 1180 would oblige the Government to make regulations requiring NICE to produce guidance on abortion services. It would also oblige NICE to make specific recommendations in the guidance. That conflicts with other provisions in the same clause that prevent central interference in the substance of the NICE recommendations. Clearly that would seriously damage the independence of NICE and its reputation for evidence-based guidance. The second part of the amendment would require health or social care bodies, or private providers of abortion services, to comply with all recommendations made by NICE, which would effectively mean that NICE was setting essential requirements for abortion services, which is not its job or function. That is the role of the Care Quality Commission, and those standards and qualities are driven by good commissioning.

Andrew Selous: We all greatly appreciate the calm and measured way in which the Minister is responding. Is she aware that, in 2006-07, a Labour-dominated Science and Technology Committee recommended that those functions should be taken over by NICE?

Anne Milton: No, and I thank my hon. Friend for raising the point. The only reason why I took his intervention was that NICE had not been given a mention yet.

Chris Bryant: Will the Minister give way?

Anne Milton: I will not, I am afraid. I must make progress.
	The amendment would not, incidentally, require local authority commissioners of abortion services to comply with NICE recommendations.
	This does not, of course, mean that NICE has nothing to contribute. Hon. Members may know that it is currently considering a draft library of NHS quality standards, which includes a proposed topic on abortion services. We may have an opportunity to air the issue further at that point.
	I hope that hon. Members are reassured by our proposals and by my personal involvement in the issue.

Chris Bryant: rose—

Anne Milton: The hon. Member for Rhondda (Chris Bryant) is clearly not reassured, but perhaps he will let me finish.
	It is a very long time since I worked in a maternity unit, but I worked in one run by the Salvation Army, and I have seen many young women go through the trauma of an unplanned and unwanted pregnancy. Yes, we need to do a great deal more to prevent unwanted pregnancies from happening in the first place, but when faced with such a situation, young, and indeed older, women need help and support to make the decision that is right for them without interference from any vested interests. The amendments were tabled in a spirit of improving services for women, but they will not work. They will not deliver what my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) wants, or what I want. They will not work for women. I urge my hon. Friend to withdraw her amendment and to work with me to ensure that we secure the right services for women.

Frank Field: I will be brief, because I know that others wish to speak.
	I thought that I would be addressing the House about an amendment with my name on it, but, for reasons unknown to me, my name was dropped from it. What I wanted to say, however—and it is reinforced by the way in which the Minister has approached the matter—is that while I thought that the original amendment involved an issue that we should consider, I believe that the Minister has dealt with it. The hon. Member for Mid Bedfordshire (Nadine Dorries) and I embarked on this journey together, and my plea to her now is not to press the amendment. The Minister has provided us with an advance which I hope will signal a change in the temper of the abortion debate in the House.
	This has been one of those debates in which people emphasise motives and rarely take voting records into account. I put my name to that amendment because in every vote on the subject that has taken place in the 30 years for which I have been in the House, I have voted against wrecking the Abortion Act, and I thought that there was an issue here that should be considered. However, I feel that the Minister has more than met the point, and she has widened the debate about what the inquiry will cover. I hope that the whole House will pay attention to her and to my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott). Presumably a report will be produced once the consultation has been completed, and perhaps we shall then be able to have a debate opened by Front Benchers in which Back Benchers’ speeches are time-limited.
	Despite what has happened today, I think it important for us to try to use this event to make it clear that we will have different debates about abortion in the House of Commons in future, for we should have such debates. We should be more concerned with facts, and less concerned with trying to put our sticky fingers into other people’s souls and pronouncing that they have failed.

Julian Huppert: I am delighted to have a chance to speak in the debate. It is tempting to respond to all the comments made by the hon. Member for Mid Bedfordshire (Nadine Dorries), but I shall avoid doing so. Instead, I shall make just two points.
	First, let me quote something that was said by the right hon. Member for Bristol South (Dawn Primarolo) before she became Deputy Speaker. She said of the hon. Member for Mid Bedfordshire:
	“The hon. Lady has asserted many things to be facts that are not… Some of the things that she is saying are not borne out by the evidence.”—[Official Report, 20 May 2008; Vol. 476, c. 263.]
	I think that that is extremely true.

Nadine Dorries: Will the hon. Gentleman give way?

Julian Huppert: Unfortunately there is not much time, but I will give way once.

Nadine Dorries: Would the hon. Gentleman care to be absolutely specific? Will he focus on what he thinks those facts are and then give me a chance to respond?

Julian Huppert: I am afraid that there will not be time to go through all that. The hon. Lady challenged me to comment on some evidence that she had provided, and then would not allow me to do so. The hon. Member for Totnes (Dr Wollaston) remarked on that.
	The Royal College of Psychiatrists has clearly done a much better systematic review than the one the hon. Member for Mid Bedfordshire (Nadine Dorries) looked at. It shows:
	“Where studies control for whether or not the pregnancy was planned or wanted, there is no evidence of elevated risk of mental health problems.”
	As I have said, that is a much more detailed review.
	Unfortunately, there is not sufficient time to cover all the other topics the hon. Lady would like to talk about. I congratulate her, however, as it takes a lot to unite Abortion Rights with the Society for the Protection of Unborn Children, both of which oppose her amendments. The SPUC has been very clear that it cannot ask MPs to support the amendments.
	Let me move on, however, and ask whether there is actually a problem that we need to address: are there too many abortions? The best way to reduce the number of abortions is by empowering individuals, by providing better access to contraception and by providing better sex and relationships education at school to both boys and girls. Are there areas where we need better advice and counselling? Absolutely, there are. People who have had a miscarriage do not get the counselling support that they desperately need. We should focus attention on that. For all the reasons that have been discussed, I urge the House to reject these amendments.
	I want to speak in favour of my amendment 1252, which proposes that evidence-based advice should be given. Although the Government will not support the amendment if it is put to a vote, I was pleased to hear that they accept the principle behind it, which is that we want that expert advice. I am not a medical doctor—I am not an obstetrician or gynaecologist—but they have clearly stated what they think the best advice is, and it should be followed. We should expect all groups giving advice to live up to this high standard. Women—all people—should get proper medical advice, and it should be the best advice available. They should not be misled, and they should not have made-up risks told to them. The Royal College of Obstetricians and Gynaecologists has excellent guidance from 2004, and all organisations should stick to it. I confirm that the British Pregnancy Advisory Service and Marie Stopes stick to that guidance, and so should all other groups.
	I trust the Government when they say that they will stick to that advice—the best medical advice. I have some concerns about some of the Government’s other comments however, and I hope to have a chance to talk to the Minister in greater detail, although this debate has not been the forum in which to do that. I urge the House to stand up for what it believes in, to reject the presentation we heard earlier and to reject the amendments.

Nadine Dorries: First, I should point out that the hon. Member for Cambridge (Dr Huppert) was referring to an older study.
	We have heard a number of points of view. I take on board the comments of the right hon. Member for Birkenhead (Mr Field) and I appreciate the response from the Minister. She is my friend, and she has gone out of her way to understand the issue and to bring this debate to a calm and reasoned conclusion.
	This debate is not just about my amendment. There are many people who support it, as I have frequently stated. [Interruption.] I have no idea why whenever I stand the hon. Member for Rhondda (Chris Bryant) always feels the need to continue chatting; he should just be quiet.
	I heard what the right hon. Member for Birkenhead said, and I have listened to the Minister. Unfortunately, I am being urged by many other people, not least those who have told their stories, to go to a vote, because there are people who want a line drawn in the sand here. I shall therefore press amendment 1221 to a Division.
	I beg to ask leave to withdraw the amendment.
	Amendment, by leave, withdrawn.

Clause 14
	 — 
	Other Services Etc. Provided As Part Of The Health Service

Amendment proposed: 1221,page9,line37, at end insert—
	‘( ) After paragraph 8 insert—
	“Provision of independent information, advice and counselling services for women requesting a termination of pregnancy
	8A (1) A local authority must make available to women requesting termination of pregnancy from any clinical commissioning group the option of receiving independent information, advice and counselling.
	(2) In this paragraph, information, advice and counselling are independent where they are provided by either—
	(a) a private body that does not itself refer, provide or have any financial interest in providing for the termination of pregnancies; or
	(b) a statutory body.’.—(Nadine Dorries.)
	Question put, That the amendment be made.
	The House divided:
	Ayes 118, Noes 368.

Question accordingly negatived
	.

New Clause 1
	 — 
	Complaints about exercise of public health functions by local authorities

‘In Part 3 of the National Health Service Act 2006 (local authorities and the NHS) after section 73B insert—
	“73C Complaints about exercise of public health functions by local authorities
	(1) Regulations may make provision about the handling and consideration of complaints made under the regulations about —
	(a) the exercise by a local authority of any of its public health functions;
	(b) the exercise by a local authority of its functions by virtue of section 6C;
	(c) anything done by a local authority in pursuance of arrangements made under section 7A;
	(d) the exercise by a local authority of any of its other functions—
	(i) which relate to public health, and
	(ii) for which its director of public health has responsibility;
	(e) the provision of services by another person in pursuance of arrangements made by a local authority in the exercise of any function mentioned in paragraphs (a) to (d).
	(2) The regulations may provide for a complaint to be considered by one or more of the following—
	(a) the local authority in respect of whose functions the complaint is made;
	(b) an independent panel established under the regulations;
	(c) any other person or body.
	(3) The regulations may provide for a complaint or any matter raised by a complaint—
	(a) to be referred to a Local Commissioner under Part 3 of the Local Government Act 1974 for the Commissioner to consider whether to investigate the complaint or matter under that Part;
	(b) to be referred to any other person or body for that person or body to consider whether to take any action otherwise than under the regulations.
	(4) Where the regulations make provision under subsection (3)(a) they may also provide for the complaint to be treated as satisfying sections 26A and 26B of the Act of 1974.
	(5) Section 115 of the Health and Social Care (Community Health and Standards) Act 2003 (health care and social services complaints regulations: supplementary) applies in relation to regulations under this section as it applies in relation to regulations under subsection (1) of section 113 of that Act.
	(6) In this section, “local authority” has the same meaning as in section 2B.”’.—(Paul Burstow.)
	Brought up, and read the First time.

Paul Burstow: I beg to move, That the clause be read a Second time.

Mr Speaker: With this it will be convenient to discuss the following:
	New clause 10—Requirements as to transparency
	‘(1) Regulations may impose requirements on the National Health Service Commissioning Board and clinical commissioning groups for the purpose of ensuring that they are open and transparent in their decisions in commissioning health services for the purpose of the NHS.
	(2) Regulations under this section may in particular impose requirements relating to—
	(a) the imposition of minimum waiting times for patients,
	(b) the imposition of clinical thresholds that a patient must reach before being eligible for treatment.
	(3) The regulations may provide for the requirements imposed, or such of them as are prescribed, not to apply in relation to arrangements of a prescribed description.’.
	New clause 11—Financial duties on clinical commissioning groups: administrative costs
	‘After section 223K of the National Health Service Act 2006 insert—
	“223L Financial duties on clinical commissioning groups: administrative costs
	(1) The Board must direct clinical commissioning groups to ensure that their expenditure on administrative costs does not exceed a prescribed percentage of their resource.
	(2) The Board must ensure that the total national limit on clinical commissioning groups expenditure on administrative costs in any year from April 2014 does not exceed 55 per cent. of the total spent on administrative costs by primary care trusts in the financial year 2009-10.”’.
	New clause 12—Secretary of State’s duty as to education and training
	‘After section 1F of the National Health Service Act 2006 insert—
	“1G Secretary of State’s duty as to education and training
	For the purposes of improving the quality of patient care, the Secretary of State has a duty to maintain a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all staff delivering NHS services.”’.
	New clause 13—Providers’ duty as to education and training
	‘For the purposes of improving the quality of patient care, all providers of services for the purposes of the health service have a duty to contribute towards the maintenance of a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all their staff delivering health services.’.
	New clause 14—Duties of clinical commissioning groups as to persons for whom they are responsible
	‘After section 3B of the National Health Service Act 2006 insert—
	“3C Duties of clinical commissioning groups as to persons for whom they are responsible
	(1) A clinical commissioning group has responsibility for persons who usually reside in the clinical commissioning group’s area.
	(2) Regulations may provide that for the purposes of this section a clinical commissioning group also has responsibility (whether generally or in relation to a prescribed service or facility) for persons who—
	(a) were provided with primary medical services by a person who is or was a member of the clinical commissioning group,
	(b) have a prescribed connection with the clinical commissioning group’s area, or
	(c) are provided with primary medical services by a member of the clinical commissioning group.
	(3) The power conferred by section 3(1B)(b) must be exercised so as to provide that, in relation to the provision of services or facilities for emergency care, a clinical commissioning group has responsibility for every person present in its area.
	(4) Regulations may provide that section 3(1A) does not apply—
	(a) in relation to persons of a prescribed description (which may include a description framed by reference to the primary medical services with which the persons are provided);
	(b) in prescribed circumstances.
	(5) The duty in subsection (1) does not apply in relation to a service or facility if the Board has a duty to arrange for its provision.”.’.
	New clause 16—Distribution of health service functions
	‘(1) The Secretary of State may direct the NHS Commissioning Board, or a clinical commissioning group, to exercise any of his functions relating to the health service which are specified in the directions.
	(2) The functions which may be specified in directions include functions under enactments relating to mental health and care homes.’.
	New clause 17—Secretary of State’s directions to health service bodies
	‘(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about its exercise of any functions.
	(2) The bodies are—
	(a) the NHS Commissioning Board; and
	(b) clinical commissioning groups.
	(3) Nothing in provisions made by or under this or any other Act affects the generality of subsection (1).’.
	New clause 18—Care Quality Commission: duty as regards stability of existing NHS services
	‘The Care Quality Commission, in exercising its functions, must have regard to the need to avoid existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research or case-load, becoming viable or unstable due to an unplanned reduction in income or caseload.’.
	New clause 20—Clinical commissioning group commissioning work: public function
	‘The Secretary of State must issue directions to clinical commissioning groups which will ensure that commissioning work is predominantly retained as a function by staff directly employed by the clinical commissioning group.’.
	New clause 23—Chief environmental health officer for England
	‘(1) The Secretary of State shall appoint a Chief Environmental Health Officer for England.
	(2) The Chief Environmental Health Officer for England shall give advice to and report to the Chief Medical Officer for England on all such aspects of environmental and public health as are relevant to the public health functions referred to in section 2A of the National Health Service 2006 Act and the duties referred to in section 2B of that Act.
	(3) The Secretary of State shall report to Parliament annually on the work of the Chief Environmental Health Officer for England.’.
	Amendment 1222, in clause 1,page2,line2, leave out ‘promote’ and insert ‘provide or secure a’.
	Amendment 1223,page2,line3, leave out from ‘must’ to ‘improvement’ in line 4 and insert ‘provide or secure a comprehensive Health Service designed to promote’.
	Amendment 1239,page2,line4, after ‘improvement’, insert ‘and to ensure improvement’.
	Amendment 1176,page2,line7, leave out subsection (2) and insert—
	‘(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.’.
	Amendment 1224,page2,line8, leave out ‘secure that services are provided’ and insert ‘provide or secure, either directly or indirectly, services’.
	Amendment 48,page2, Leave out lines 10 to 12 and insert—
	‘(3) The services so provided must be free of charge.’.
	Amendment 1174,page2,line10, after ‘services’, insert ‘so’.
	Amendment 1175,page2,line10, leave out ‘as part of the health service in England’.
	Amendment 1177,page2,line12, at end insert—
	‘(4) For the purposes of this Act “the health service in England” is defined as those services provided under section 3 of this Act.’.
	Amendment 1240,in clause 2, page2,line17, leave out ‘with a view to securing’ and insert ‘so as to ensure’.
	Amendment 1241,page2,line23, leave out ‘with a view to securing’ and insert ‘so as to ensure’.
	Amendment 1212,page2,line33, at end insert—
	‘(5) In discharging the duty under subsection (1) the Secretary of State retains the power to create a new NHS trust or provider organisation.’.
	Amendment 1169,in clause 3, page2,line38, leave out from ‘State’ to end of line 40 and insert ‘, so far as is consistent with the interests of the health service, must exercise the functions conferred by this Act so as to secure—
	(a) that inequalities between the people of England with respect to the benefits that they can obtain from the Health service are reduced, and
	(b) a continuous reduction of inequalities between the people of England with respect to the outcomes achieved for them.
	‘(2) The Secretary of State must publish and lay before Parliament an annual report detailing the progress which has been achieved in discharging this duty, and the means by which the Secretary of State intends to fulfil this function in the following year.’.
	Amendment 1183,page2,line38, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to reducing’.
	Amendment 1197,page3,line1, leave out Clause 4.
	Amendment 1194, in clause 5,page3,line16, leave out ‘have regard to the need to’.
	Amendment 1242, in clause 9,page5,line32, at end insert—
	‘(h) promoting co-operation between each of the authority’s relevant partners.’.
	Amendment 1243,page5,line35, at end insert—
	‘(4A) For the purposes of this section each of the following is a relevant partner of a local authority—
	(a) where the authority is a county council for an area for which there is also a district council, the district council;
	(b) the police authority and the chief officer of police for a police area any part of which falls within the area of the local authority;
	(c) a local probation board for an area any part of which falls within the area of the local authority;
	(d) a youth offending team for an area any part of which falls within the area of the local authority;
	(e) a clinical commissioning group for an area any part of which falls within the area of the local authority.
	(4B) The relevant partners of a local authority must co-operate with the local authority in the making of arrangements under this section.’.
	Amendment 5,page5,line43, leave out Clause 10.
	Amendment 1178, in clause 11,page7,line15, leave out from ‘Subsections’ to ‘apply’ and insert ‘(1), (3) and (4) of section 3C’.
	Government amendment 49.
	Amendment 1172, in clause 14, page9,line35, after ‘blood’, insert ‘, haematopoietic stem cells’.
	Amendment 1173,page9,line37, after ‘tissue’, insert ‘, haematopoietic stem cell’.
	Government amendments 50, 51 and 54.
	Amendment 42, in clause 20,page16,line34, at end insert—
	13DA Duty of the Board as to commissioning of services
	In carrying out its duties in respect of the commissioning of services the Board must in the exercise of its functions have regard to the interdependency of services and the impact that the arrangements for the provision for one service may have on the financial and clinical sustainability of other services.’.
	Amendment 1198,page17, leave out lines 12 to 19.
	Amendment 1184,page17,line21, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to’.
	Amendment 1185,page17,line23, leave out ‘reduce’ and insert ‘reducing’.
	Amendment 1186,page17,line25, leave out ‘reduce’ and insert ‘reducing’.
	Amendment 1187,page17,line36, leave out ‘act with a view to enabling’ and insert ‘have regard to the need to enable’.
	Amendment 1188,page18,line4, after ‘functions’, insert ‘have regard to the need to’.
	Amendment 1195,page18,line17, leave out ‘have regard to the need to’.
	Government amendment 60.
	Amendment 1203,page19,line28, at end insert—
	13OA Duty as regards stability of existing NHS services
	The Board must not exercise its functions, in particular in respect of section 13I (Duty as to patient choice) or 13K (Duty to promote innovation) in a way which could lead to existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.
	Amendment 46,page22,line12, at end insert—
	‘(1A) The Secretary of State must publish guidance to the Board, to which the Board must have regard, about the exercise of its powers under subsection (1).’.
	Amendment 1167,page24,line16, at end insert—
	‘Duty to reduce bureaucracy
	132ZA Duty to reduce bureaucracy
	‘(1) The Board must exercise its powers so as to reduce administrative costs in the NHS.
	(2) For that purpose the Board must exercise its duties under 14A and 14C to ensure that at no time there exist more clinical commissioning groups than there were primary care trusts on 1 April 2011.’.
	Government amendments 67 and 68.
	Amendment 1206,page26,line41, at end insert—
	223E1 Financial duties of the Board: needs-based allotments
	(1) The Board must make allotments to clinical commissioning groups based solely on the need of the population served by each commissioning group.
	(2) The Secretary of State may give directions as to how the needs set within subsection (1) are determined.’.
	Amendment 1218,in clause 22, page27,line17, at end insert ‘provided that the members of a clinical commissioning group cannot consist entirely or mainly of persons who are providers of primary medical services under section 83(2).’.
	Amendment 1211,page27,line22, at end insert—
	‘(c) shall be co-terminus with the social services local authority, unless it is notified by the relevant health and wellbeing board, and the local authority, that they approve an area which is not co-terminus.’.
	Government amendments 70 and 71.
	Amendment 43, in clause 23,page34,line20, at end insert—
	14PA Duty of clinical commissioning groups as to commissioning of services
	In carrying out its duties in respect of the commissioning of services each clinical commissioning group must in the exercise of its functions have regard to the interdependency of services and the impact that the arrangements for the provision for one service may have on the financial and clinical sustainability of other services.’.
	Amendment 1189,page35,line2, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to’.
	Amendment 1190,page35,line3, leave out ‘reduce’ and insert ‘reducing’.
	Amendment 1191,page35,line5, leave out ‘reduce’ and insert ‘reducing’.
	Amendment 1192,page35,line22, leave out ‘act with a view to enabling’ and insert ‘have regard to the need to enable’.
	Amendment 1193,page35,line36, after ‘functions’, insert ‘have regard to the need to’.
	Amendment 1196,in clause 20, page36,line3, leave out ‘have regard to the need to’.
	Amendment 1230, in clause 23, page36,line7, leave out from ‘consortium’ to ‘that’ in line 8 and insert ‘has a duty to secure’.
	Amendment 1231,page36,line16, leave out from ‘consortium’ to ‘that’ in line 17 and insert ‘has a duty to secure’.
	Amendment 37,page36,line36, at end insert—
	14YA Duty as to conflicts of interest
	(1) Each clinical commissioning group must exercise its functions so as to ensure that any conflicts of interest, and personal and prejudicial interests are dealt with.
	(2) The Secretary of State must issue guidance on how conflicts of interest and personal and prejudicial interests should be dealt with by clinical commissioning groups as part of their decision making.’.
	Amendment 1204,page36,line36, at end insert—
	14YA Duty as regards stability of existing NHS services
	Each clinical commissioning group must not exercise its functions, in respect of section 14U (Duty as to patient choice) or 14W (Duty to promote innovation) in a way which could lead to existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.
	Amendment 41,page36,line43, leave out from second ‘are’ to end of line 44 and insert ‘fully consulted—’.
	Amendment 45,page38,line22, at end insert—
	‘(1A) The Secretary of State must publish guidance to commissioning consortia about its exercise of powers under subsection (1), to which each commissioning consortia must have regard.’.
	Amendment 1181,page38,line26, at end insert—
	‘(3) For the avoidance of doubt it is hereby declared that nothing in this section authorises a clinical commissioning group—
	(a) to disregard any enactment or rule of law, including but not limited to section 1(3), or to override any person’s contractual or proprietary rights; or
	(b) to charge for anything the group does in the exercise of its powers under this section which relates to any accommodation, service or facility of a type to which section 3(1) applies; or
	(c) to charge for anything in relation to the exercise of its functions under section 3 or 3A.
	(4) A clinical commissioning group shall exercise the powers specified in section 7(2)(f) only after consulting (to the extent that it appears to it to be practical) any person who appears to it to have an interest through its own previous research in the ideas or intellectual property in question as to whether it should exercise them and, if so, as to any financial arrangements.
	(5) A clinical commissioning group shall demonstrate in its annual report under section 14Z3 how the exercise of its power conferred by subsection (1) has not interfered to a significant extent with the performance by the group of its functions.
	(6) Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.’.
	Amendment 1250,page41,line38, at end insert—
	‘(6A) If the opinion of a Health and Wellbeing Board given to the clinical commissioning group under subsection (5) is that the Health and Wellbeing Board does not consider that the draft takes proper account of each joint health and wellbeing strategy referred to in that subsection, and if the clinical commissioning group does not so consider it, the group shall inform the Health and Wellbeing Board, whereupon it may report to the Secretary of State that it does not consider that such a plan takes proper account of any such strategy and the Secretary of State may require the clinical commissioning group to carry out such further consultation with the Health and Wellbeing Board as he considers appropriate, or may make a final decision on the plan and require the Commissioning Board or the clinical commissioning group to take such action, or desist from taking such action, as he may direct.’.
	Amendment 1171,page42,line23, at end insert—
	‘(3) If in the Board’s opinion, having considered any opinion submitted to it by a Health and Wellbeing Board under 14Z12(1)(a), the plan published by the clinical commissioning group does not take proper account of each joint health and wellbeing strategy published by the Health and Wellbeing Board which relates to the period (or any part of the period) to which the plan relates, the Board must instruct the clinical commissioning group to revise its plans under 14Z10(1).’.
	Amendment 1202,page42,line23, at end insert—
	14Z12A Power of Referral of Commissioning plans to the Secretary of State
	(1) If the Health and Well-being Board is of the opinion under section 14Z12(1) that a plan published by the CCG under section 14Z9(6) or 14Z10(2) and which is submitted to it in accordance with section 14Z9(6) and 14Z10(3) or 14Z11(4) or (8), does not take proper account of any relevant joint health and wellbeing strategy it may refer the matter to the Secretary of State for a decision.
	(2) Regulations under this section may provide for the mechanism by which such referrals are made.’.
	Amendment 38,page43,line9, at end insert—
	‘(ab) section 14YA’.
	Amendment 1199,in clause 24, page49,line35, leave out from beginning to end of line 37 on page 50.
	Amendment 1213,page50,line27, at end insert ‘and must consult with local Health and Wellbeing Boards prior to any decision on this matter with a view to securing their agreement.’.
	Amendment 1255, in clause 27,page53,line5, leave out ‘the Secretary of State’ and insert ‘Public Health England’.
	Amendment 1256,page53,line6, leave out ‘an’ and insert ‘a suitably qualified’.
	Amendment 1257,page53,line20, after ‘authority’, insert ‘, reporting to the Chief Executive of that authority,’.
	Amendment 1253,page53,line21, at end insert ‘, and will be accountable to—
	(a) the local authority, and
	(b) the Secretary of State for Health.’.
	Amendment 1258,page53,line21, at end insert—
	‘(2A) The individual so appointed is to be employed by Public Health England, which shall have responsibility for their professional qualification and development.’.
	Amendment 1259,page53,line30, after ‘authority’, insert ‘or Public Health England’.
	Amendment 1254,page53,line42, leave out ‘consult’ and insert ‘obtain the agreement of’.
	Amendment 1260,page53,line42, leave out ‘the Secretary of State’ and insert ‘Public Health England’.
	Amendment 7,in clause 29, page54,line30, at end insert—
	‘(3) This section comes into force on a date to be specified by order by the Secretary of State.
	(4) The time specified in subsection (3) must be after such time as the Secretary of State is satisfied that the workforce education and training functions of strategic health authorities are being fulfilled by another body.’.
	Amendment 1237,page256,line31, leave out Clause 299.
	Amendment 1238,page257,line29, leave out Clause 300.
	Amendment 47,in clause 304, page261,line19, at end insert—
	‘(1A) Section 29 comes into force in accordance with sections 29(3) and (4).’.
	Amendment 1245,in schedule 2, page269,line21, leave out from ‘consortium’ to end of line 24.
	Amendment 1244,page269, leave out lines 25 to 29 and insert—
	‘(3) The arrangement must include provision for the functions of the clinical commissioning group to be exercised by, and only by, its employees on its behalf.’.
	Amendment 1249,page269, leave out line 29.
	Amendment 1234,page269,line29, at end insert—
	‘(4) Nothing in paragraph (3) shall authorise the inclusion of any provision for any of such functions to be exercised by—
	(a) any of the clinical commissioning group’s members who hold or benefit from contracts to provide primary medical services under section 83(2); or
	(b) individuals who have been employees of such members; or
	(c) by a governing body, committee or sub-committee which consists entirely or mainly of such members.’.
	Government amendments 292 to 299.
	Amendment 1170,in schedule 4, page278, leave out lines 35 and 36 and insert—
	‘(a) omit “Strategic Health Authorities” and insert after “(a)”— “the National Health Service Commissioning Board”, and
	(b) omit “Primary Care Trusts” and insert after “(b)” — “Clinical Commissioning Groups”.’.
	Amendment 1247,page281,line10, at end insert—
	‘(2A) Regulations made under this section must specify that—
	(a) direct payments can not be made in respect of the whole or part of a course of private health care or in respect of insurance premiums which have the purpose of providing healthcare, and
	(b) direct payments can only be made in respect of services which NICE has specified are services that can be provided by the health service, having particular regard to safety, efficacy and cost-effectiveness.’.
	Amendment 1248,page281,line23, at end insert—
	11A In section 12C (Direct payments pilot schemes) omit subsection (8).’.
	Amendment 31,in schedule 23, page417, leave out lines 18 to 21.
	Amendment 32,page418,line34, leave out lines 5 to 8.

Paul Burstow: I rise to support the Government’s amendments and to explain the Government’s thinking on the amendments tabled by Opposition Members and other Members in the House. This large group of amendments covers a range of key clauses that enable us to deliver on a number of key tenets of the Bill. First, an NHS led by clinicians; secondly, an NHS with quality at its heart; thirdly, an NHS that is open and collaborative; and, fourthly, an NHS with clear, stronger political accountability. It is on the last point that I would like to start my remarks today.
	The role of the Secretary of State has been the subject of great debate, especially in recent weeks. It is right that we should have this debate and it is a very important issue, especially given its particular complexity, but let us ensure that the debate is based on the facts. Too often, opinions have been offered and accusations made without full knowledge of what the Bill does and does not do.
	Let me start by clearly setting out what the Bill does not do. First, it is absolutely not the Government’s intention in this Bill to allow the Secretary of State to wash his hands of the NHS. The Government believe in a comprehensive, tax-funded NHS that is free at the point of use, based on need and not ability to pay. Nothing in this Bill will change that. Secondly, I want to reassure hon. Members that there is no question but that the vast bulk of NHS-funded health care will continue to be delivered by NHS bodies that are bound by law and their constitutions to remain as public sector bodies and to fulfil a primary duty of providing services to the NHS. Indeed, the Bill contains a new provision—for the first time—specifically to prevent any future Secretary of State or NHS bodies from acting to promote the private sector over the public sector.
	Let me turn to what the Bill does. It ensures not only that the Secretary of State will remain politically and legally accountable for a comprehensive health service but that he will retain the capacity to intervene where necessary to ensure that a service is provided.
	Let me start with the accountability of the Secretary of State. Not only does the Secretary of State retain a raft of specific duties that mean he cannot wash his hands of the NHS but the Bill retains the legal requirements that services should be free of charge except where already specified. It now includes requirements, too, on securing continuous improvement in the quality of services, on promoting research and the use of evidence learned from research and, for the first time ever, on the need to have regard to the need to reduce health inequalities.

Helen Jones: Will the Minister explain to the House why, rather than providing a duty to act to reduce health inequalities, the Bill only requires bodies to have regard to health inequalities? It is quite possible to have regard to them and to do nothing to reduce them.

Paul Burstow: There is a clear duty on the boards to act, too, and I ask the hon. Lady why the Labour Government, in 13 years, chose not to do anything about that matter. There was never a legal duty of any sort in the past and we now have clear duties on all the bodies and on the Secretary of State. Of course, I shall come on to talk about the mandate, which has a role to play, too.

Andrew George: I merely wish to seek clarity from my hon. Friend on some of the briefings that his Department has been putting out about the duty to provide, to which he has referred already. Those briefings indicate that there was somehow no provision in the National Health Service Act 1946 for a duty on the Secretary of State to provide. I wanted my hon. Friend to acknowledge that section 1(1) states
	“and for that purpose to provide or secure the effective provision of services in accordance with the following provisions of this Act.”
	Equally, the National Health Service Act 1977 contains the same reference to the
	“purpose to provide or secure”.
	The requirement to provide or secure is repeated throughout all the Health Acts.

Paul Burstow: I am grateful to my hon. Friend for that intervention. If he listens carefully to what I am saying, he will hear that I am developing an argument that will go towards answering that question. Rather than trying to answer it in a very small way now, I would rather answer it in a comprehensive way through reference to what I had planned to say to the House.
	As I was saying, hon. Members should ask themselves how the Secretary of State would be able to wash their hands of the NHS while simultaneously being legally required to deliver on all the duties I have just outlined. Crucially, the Secretary of State also retains the duty to promote a comprehensive health service, which dates from the Act that founded the NHS in 1946 and has been unchanged by this Bill. The Secretary of State will also have the duty to secure that services are provided for that comprehensive health service and he will have failed in that duty if they are not.
	The Secretary of State also has the ability—the obligation, in fact—to set goals and priorities for the NHS through the mandate. That will set out what the Secretary of State wants the NHS to deliver, which will be updated every year. It will be widely consulted on and Parliament will scrutinise it, giving Parliament a detailed say in what the NHS is tasked to deliver for the first time ever.
	The Secretary of State has further powers in addition to the mandate to impose standing rules by which the NHS commissioning board and the clinical commissioning groups must operate, which will be subject to scrutiny and control by Parliament—a power Parliament does not currently have. What is changing, however, is the Secretary of State’s relationship with the NHS in terms of the role of Ministers in the commissioning and provision of services to the NHS. The Government believe that it should not be the job of Ministers to provide directly or commission NHS services, either. It should be the role of front-line professionals, who should have the freedom to focus on driving up quality of care,
	free from interference by Ministers in operational decisions—something that all parties in this House have said that they want to see.
	We understand that all Government legislation has a responsibility to foresee the unforeseeable, to ask questions about the worst-case scenario and to ensure that the answers stand up to scrutiny. That is why this Bill contains a number of back-stop provisions to make it absolutely certain that any future Secretary of State will not be able to turn a blind eye to failings of service provision, so we have ensured that the Secretary of State has the power to step in if the board, or Monitor, are failing to deliver on their duties, including any duties imposed on the board through the mandate.
	Finally, in the event of a significant emergency such as a pandemic, the Secretary of State will have powers to direct any commissioner or provider of NHS services.

Owen Smith: In the event where there is not an emergency, will the Minister confirm that under the new provisions the Secretary of State will not have the power, as he has, to direct a commissioning group to do what he thinks is appropriate for the people in that area?

Paul Burstow: No, he will not have powers of direction. Of course, powers of direction are not subject to any form of parliamentary scrutiny and can be issued by a Secretary of State on their fiat. In future, this House, through regulations, will be able to look at and agree to—or not—standing rules that in most effects will have the ability to direct clinical commissioning groups and the NHS commissioning board on a wide range of matters. I direct the hon. Gentleman to clause 17, which sets those out at great length.

Simon Hughes: I am listening very carefully and, as my hon. Friend knows, we have had conversations and a wider debate about this issue. I understand what he is saying about the specific power of the Secretary of State both to act and to direct if things are failing, but does he accept that some of us would still like to be persuaded that the best way of enunciating the fundamental duty at the beginning of the legislation is not to say that the principal job is to secure the provision of the services of the NHS but to write in that it is to provide them? The back-stop encompassing statement, as it were, would mean that we could be sure that the duty rested with the office holder of the role of Secretary of State in England at any one time.

Paul Burstow: I am grateful to my right hon. Friend for having given me the opportunity to talk about this at some length, and I want to give him some reassurance. However, it is hardly a back-stop to have in clause 1 something that is not what the Secretary of State on a day-to-day basis actually does. It is a back-stop to say that when things fail, the Secretary of State should be able to exercise those functions to make sure that things are put right. I would like to say a bit more about that now.
	I want it to be clear that we do not envisage the Secretary of State having to intervene other than in exceptional circumstances. Nevertheless, the measures are the legislative back-stops in the Bill and it is right that they are there to protect the comprehensive nature of our NHS and to provide reassurance. To answer my
	right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) directly, there are a number of ways in which the Secretary of State could secure the provision of services. In particular, he could impose requirements on the NHS commissioning board and clinical commissioning groups using both the mandate and the standing rules. He could establish, and has the powers to do so, a special health authority, and could direct it to carry out any NHS function. That power has been used in the past to establish NHS Direct—a service-providing organisation. Also, he could intervene, including by replacing the management and directing them in the event of a significant failure. Those measures are the belt and braces in the Bill to make it absolutely sure that the NHS and the public are protected from all eventualities. We have ensured that the Secretary of State’s powers are sufficient to ensure that a comprehensive NHS is provided, including through the public sector, rather than simply relying on existing providers and the market.
	The position is clear: we are giving the NHS more freedoms and autonomy—something that many of us in the House have for many years argued should take place—and we are increasing its accountability. We are making watertight the obligations to provide a comprehensive health service that is free to all, based on need and not ability to pay.

John Pugh: Will the Minister confirm that the Secretary of State will retain his powers to create new hospital trusts and that the Bill does not change that power ?

Paul Burstow: The power to establish NHS trusts is contained in previous legislation. The Bill provides for, in due course, the repeal of the provision to establish NHS trusts. As we indicated in our response to the NHS future forum, that will not take place for several years to come. Regardless of that, however, the Secretary of State will retain the power to establish special health authorities that can exercise a provider function.

Rosie Cooper: The Minister just said that the Secretary of State will have the power directly to remove the management of hospitals or provider organisations. Will that apply both to NHS and private providers? Will the Secretary of State’s reach go that far?

Paul Burstow: We discussed yesterday at some length the role of Monitor and its powers through the licensing regime, which will apply not just to NHS public sector providers but to private and voluntary sector providers. The powers there are extensive and I recommend that the hon. Lady should look at the debate we had yesterday.
	Another issue that comes up is the duty of autonomy. Amendment 1197, which was tabled by my hon. Friend the Member for St Ives—not all of Cornwall—(Andrew George), seeks to remove clause 4, entitled, “The Secretary of State’s duty as to promoting autonomy”. This clause was highlighted by the legal team advising 38 Degrees about the changes to the role and functions of the Secretary of State. The specific purpose of the autonomy duty is to free front-line professionals to focus on improving outcomes for patients rather than looking up to Whitehall. It does not undermine the overarching duty to promote a comprehensive health service, nor enable Ministers to abdicate responsibility for the NHS.
	It is our view that the legal opinion published by 38 Degrees overstates the effect of clause 4. The opinion suggests that the court will expect the Secretary of State to demonstrate that any steps he took that interfered with the autonomy were “really needed”, or “essential”, and that no other course of action could be followed. This is not the Government’s intention and we do not believe that that is the effect of the clause. It would be sufficient for the Secretary of State to demonstrate that he had reasonable grounds for concluding that a course of action was the most effective way to act in the interests of the health service and fulfil a duty imposed on him by, for example, clause 1 or a new section 1A in the Bill.
	I understand, however, and I am aware that despite the provisions in the Bill there are still concerns about the role of the Secretary of State. It is understandable, when we are talking about the future of our most treasured national institution, that people should express their concerns and not be willing to tolerate even a sliver of doubt about the safety of the NHS in the future. We are determined to eliminate the doubt that has grown in people’s minds and we are certain that clause 1 is watertight in framing the legal responsibilities of the Secretary of State.
	There seems to be some doubt in hon. Members’ minds about whether other parts of the Bill could in some way prejudice those responsibilities, in particular because of the establishment of autonomous bodies that act under their own legal powers and mandate rather than under the direction of the Secretary of State. For example, some have claimed that the Secretary of State might be able to hide behind clause 4 and take a hands-off approach even if services were in crisis, but that certainly is not our intention. We are therefore willing to listen to the concerns that have been raised and, if necessary, to offer clarification or make amendments to put beyond legal doubt the fact that the Secretary of State remains responsible and accountable for the comprehensive health service that we all want to see.

Andrew George: rose—

Simon Hughes: rose—

Paul Burstow: I will give way to my right hon. Friend the Member for Bermondsey and Old Southwark and then I shall make some progress because this is a very big group of amendments.

Andrew George: It is my amendment.

Simon Hughes: I am very grateful and I will not keep the Minister long. I have listened very carefully, as colleagues will have done, to my hon. Friend’s extremely reassuring comments. If he and the Secretary of State are committed to working on some wording that will alleviate concerns at the beginning of the Bill, I know that my colleagues and I will be very happy to work with him.

Paul Burstow: I am grateful to my right hon. Friend. I can say no more than I have said and I think I have said what is necessary to make the Government’s intentions clear. Of course, I will now give way to my hon. Friend the Member for St Ives (Andrew George), who has been so diligent in tabling so many amendments.

Andrew George: I am grateful to my hon. Friend for giving way and for his appreciation of the efforts I am making. I, too, appreciate his comments on the Government’s intentions. It has not been my argument at any stage to suggest that the Government’s intentions are dishonourable. He has mentioned the possibility of tabling amendments, but may I have some reassurance that this is a genuine and serious issue—that we need to have policy, but also, clearly, the restraint of the Secretary of State at the same time?

Lindsay Hoyle: Order. We must have shorter interventions, as we have a lot to get through. Hon. Members should not take advantage of the Minister’s generosity in giving way.

Paul Burstow: I am grateful for your protection, Mr Deputy Speaker. I will take that as advice in relation to further interventions.
	I have heard my hon. Friend’s comments and I think he needs to look again at what I have said. I have been very clear that we are listening and that, if necessary, we will offer clarifications or further amendments, and I am very happy, as is the Secretary of State, to carry on those discussions.
	There are a number of amendments regarding other duties on the Secretary of State that I believe would not improve the drafting of the Bill. Amendments 1240, 1241, 1169 and 1183 seek to revise the duties of quality and inequality. I know that the amendments are well meant, but they would make the duties undeliverable. The Secretary of State cannot improve quality and reduce inequalities in isolation, and the duties have to reflect that. Amendment 1194 is unnecessary as the Bill already recognises the need to promote research and the use of research evidence, and creates, for the first time, responsibilities for taking a whole-system approach to achieving this. Amendments 1184 to 1193, 1195, 1196 and 1198 seek to change the extent of similar duties on the board and the clinical commissioning groups. Each of the board’s and clinical groups’ duties has been drafted to ensure that the duty is suitably strong, realistic and appropriate.
	Let me address the role of the Secretary of State in relation to another issue that has been misunderstood—charging. I want to be very clear that nothing in the Bill enables the board or clinical commissioning groups to charge for services provided as part of the comprehensive health service. Services will remain free at the point of need, except where legislation specifically allows for charges to be made—for example, prescription charges and charges for dentistry. The Government have also committed not to introduce any new charges.
	Amendment 48, tabled by the hon. Member for Brighton, Pavilion (Caroline Lucas), who is not in her place at the moment, would prevent charges from being imposed for any service provided by the NHS. It has always been possible for Ministers to provide for charges for certain health services. There are limited provisions for charging even in the original NHS legislation introduced by Nye Bevan and the Labour Government of 1946. Under the current system, there are extensive exemptions: about 60% of the English population do not pay prescription charges, but—it is an important but—NHS charging raises over £1 billion a year of revenue that is ploughed back into services for patients,
	and it does make an important contribution to the overall affordability of the NHS. Therefore, I cannot accept the amendment.
	On direct payments, the hon. Member for Brighton, Pavilion also tabled several amendments on direct payments. The amendments are unnecessary and too restrictive. Amendment 1247 would restrict direct payments to being spent on services approved by the National Institute for Health and Clinical Excellence. The great opportunity of personal budgets is that they allow people in areas where less medicalised services are provided to have much greater control over aspects of their care—those community-based services that are so important in maintaining the quality of life for many people with long-term conditions.
	Finally, amendment 1248 would remove the power to extend direct payments nationally following the pilots, which are continuing. The Health Act 2009 provided that direct payments could be extended with the active agreement of Parliament using the affirmative procedure, and that seems a perfectly reasonable way of having a parliamentary check over the outcomes of the pilots that will be reported to the House next year. Amendment 1247 would prevent direct payments from being used for private health care or health insurance. The amendment is unnecessary. NHS funds could never be used to pay people’s private health insurance premiums.
	I shall now turn to education and training. We have already committed to introduce at a later stage in the Bill’s proceedings an explicit duty for the Secretary of State to maintain a system for professional education and training. Work is ongoing and an amendment will be tabled in the House of Lords. That will be more effective and more precise than the long-term measure of simply blocking the abolition of strategic health authorities, so amendments 7 and 47 will not do.
	Our vision of a modern NHS has clinical commissioning at its very heart. We want clinicians, GPs, nurses and other health care professionals to have the autonomy to commission innovative new services, and to have the true responsibility that the previous Government denied them. That involves striking the right balance between freedoms for clinical commissioning groups and their essential responsibilities to other parts of the health care service.
	We made many changes in response to the recommendations of the NHS Future Forum report. We always wanted clinical commissioning groups to have a robust set of governance arrangements, to involve a wide range of other professionals and to be transparent in how they conducted their business, and we have now further strengthened those parts of the Bill so that they are very much improved.
	As I said at the start of my remarks, I should like to speak briefly to a number of amendments, as I am conscious that many other hon. Members wish to speak. First, I will address some amendments that are very similar, if not identical, to those that we had the opportunity to debate at least once, and possibly twice, during the first stage of the Committee and in the re-committed Committee.
	Amendment 1181, which is like amendments 45 and 46, seeks to restrict clinical commissioning groups’ powers to raise additional income. As was explained in Committee, those amendments are unnecessary. The Secretary of
	State has already published guidance, which can be easily updated, specifically on the powers to generate income, which applies to current NHS bodies, including primary care trusts.
	Amendments 37 and 38 are on conflicts of interest. We have listened to the concerns that were expressed in the listening exercise and made changes, so the Bill already requires clinical commissioning groups to make provision for dealing with conflicts of interest.
	Amendments 31 and 32 would prevent any property currently held by PCTs or strategic health authorities from being transferred to any provider that is not a public authority. As we said in Committee, we have no intention of giving away NHS property to private companies. That will not be the case and, given the safeguards that are in place, it cannot happen.
	Several amendments have sought to probe accountability within clinical commissioning groups. I repeat what we said in Committee. A clinical commissioning group is not able to delegate its statutory responsibilities for carrying out its functions. It cannot palm them off or pass them on to others. Amendment 1245 would limit representation on CCG committees and sub-committees, preventing those clinical commissioning groups from inviting other professionals and experts to participate—something that we were told during the listening exercise was widely welcomed and wanted.
	Amendment 1249 restricts the use of sub-committees—an essential part of any organisation with a wide range of functions. Similarly, amendment 1234 would prevent GPs or their employees from working on behalf of a clinical commissioning group, which would be a severe constraint on those groups’ ability to function. Amendment 1244 would prevent a clinical commissioning group from delegating its functions to anyone other than its employees. That would make it very difficult for those groups to carry out their statutory functions effectively.
	New clause 20, tabled by my hon. Friend the Member for St Ives, similarly would restrict the support that clinical commissioning groups can draw on. We want to allow those groups to access the best support and advice available—to be able to work with local authorities, third sector organisations and charities, research organisations and the independent sector. I mentioned in Committee several times, and it is worth repeating, that the support organisation established by the Neurological Alliance is proving of invaluable assistance to commissioners, and amendments such as new clause 20 would prevent it from doing the work it does for the clinical commissioning groups. I can follow the intention behind the amendments, but I hope my reassurances about the final responsibility—the statutory responsibility—for decision making in clinical commissioning groups resting with their members and the governing body are clear.
	There is a raft of amendments dealing with the relationship between local authorities and commissioning groups. We want that to be a dynamic relationship, with constant dialogue and collaboration, which is precisely why the Bill proposes the establishment of health and well-being boards. Amendments 1202, 1171 and 1250 would introduce a new, centrally imposed procedural requirement on health and well-being boards and clinical commissioning groups. Clinical commissioning groups will have a duty to have regard to the relevant joint health and well-being strategy.
	Where commissioning plans vary significantly from the joint strategy, the group will need to justify or consider amending its plans. Health and well-being boards also have the power to refer their views and concerns to the NHS commissioning board when they feel that the plans have not had proper regard to the joint health and well-being strategy. That indicates to the NHS commissioning board that the health and well-being board believes the CCG is actively failing to fulfil its duties. Anything further would undermine the important balance that needs to be struck in what is fundamentally a partnership relationship between two organisations that have separate sets of sovereignties and responsibilities.
	The importance of that partnership approach highlights why it would be impossible to create an obligation on clinical commissioning groups to act alone to secure integration of services. How can one body decide to integrate with another against the wishes of the other? So a duty cannot be imposed on one side unless the relationships exist that will allow that to take place. That can be achieved only by both parties working together, and for that reason amendments 1230 and 1231 do not contribute to that relationship’s working well.
	Amendment 1211 seeks to make the clinical commissioning groups coterminous with local authorities. We have accepted the NHS Future Forum’s recommendation that the boundaries of local clinical commissioning groups should not normally cross those of local authorities, with any departure needing to be clearly justified as part of the establishment process set out in the Bill.
	Amendment 1213 would prevent a clinical commissioning group that had received a reward under the quality premium from using that money without first securing the agreement of the local health and well-being boards. That would severely limit the CCG’s freedom to spend its quality payment as it saw fit. Health and well-being boards will shape commissioning priorities through the joint health and well-being strategy, by being consulted by the CCG on their commissioning plans. Under the duties set out in proposed new section 14Z14 of the National Health Service Act 2006, the NHS commissioning board must also consult each relevant health and well-being board in making its annual performance assessment of those CCGs.

Rosie Cooper: Great play keeps being made about consultation. I do not hear any play being made about the right to be heard or a right of veto, or whatever. CCGs can ask the health and well-being boards what they think; health and well-being boards might make a recommendation, but there is no obligation for anyone to listen.

Paul Burstow: The hon. Lady is completely wrong when she says that there is no obligation. There are clear duties in the Bill for health and well-being boards’ views, and their preparation of joint strategies on health and well-being and joint strategic needs assessments, to be legally binding documents, in the sense that CCGs must have regard to them. They are not pieces of paper that can be just tossed aside and dismissed. They are very important documents in the emerging system.

Stephen McCabe: A number of us are trying to understand what will trigger some kind of higher-level arbitration if it becomes abundantly clear to a significant group of people in a local community that the health and well-being board’s view is not being properly considered by the CCG. At that point, when there is a clear conflict, how will that conflict be exposed so that the Secretary of State or someone else clearly arbitrates so that there is fairness, not lip service? A lot of people are anxious about that.

Paul Burstow: That anxiety was expressed in Committee by some Opposition Members. As a result of the NHS Future Forum’s recommendations, we have put in place further checks to ensure that those concerns are allayed. Not least of those—as well as our view that the health and well-being boards should have on them a majority of elected councillors—is that they will have clear rights of membership from the local healthwatch, which will be listening to the wider community and will represent those wider concerns. They will have the views and expertise of director of public health, the director of adult social services and the director of children’s services. If they feel that the strategy that they have all agreed is not being honoured in the commissioning strategy, they can ultimately refer that matter to the NHS commissioning board, and that can lead to changes being made.

Helen Jones: Many of us are concerned that we will not know properly what is going on in CCGs, because there is no requirement for them to be subject to the Public Bodies (Admission to Meetings) Act 1960 and to meet in public. They can decide whether to meet in public. How on earth is accountability to be maintained if those bodies can decide in private—[Hon. Members: “No, they can’t.] Yes, they can. They can decide in private how they will consider input from the health and well-being boards, and what they will do about it. Where is the line of public accountability?

Paul Burstow: I fear that, unfortunately, the hon. Lady might well have dusted down an old copy of the Bill, before the Future Forum made its recommendations and we made amendments to make it absolutely clear that a CCG’s governing board must meet in public. That is the decision-making body. Moreover, we also require those boards to set out in detail and publish all their decision-making arrangements—unlike PCTs, whose decisions could be made in private and no one would know.
	Let me move on to health and well-being boards influencing commissioning decisions. Other people have questioned why we should have a quality premium at all. Indeed, amendment 1199 would remove the NHS commissioning board’s ability to reward CCGs financially for the quality of services—I emphasise that—and the outcomes that they secure, or reductions in health inequalities, which is something that all hon. Members across the House want to be promoted. That is the basis on which we want things to move forward, and high-quality services should be recognised and rewarded.
	With amendments made in the second Bill Committee, we made it absolutely clear that such payments will provide an incentive to CCGs to focus on improving quality and outcomes. We will work with patients and professional groups to draft the regulations to reinforce that clear undertaking, which was made as a result of listening.

Stephen McCabe: Will the Minister give way?

Paul Burstow: I am conscious of the time, and the fact that other hon. Members want to move and speak to other amendments. If the hon. Gentleman will forgive me, I will make a bit more progress.

Andrew George: Will the Minister give way?

Paul Burstow: I am talking about my hon. Friend’s amendment, so I will, of course, give way.

Andrew George: I am grateful to the Minister for giving way to me, as he is referring to my amendment. I think that I understand what the Government are trying to achieve here, but in order to assess properly what quality and outcomes are, that assessment must not be pre-empted. The purpose of my amendment is to ensure that good quality and outcomes are not rewarded too early after treatment, before people can make a proper assessment and know the long-term impact of a new procedure.

Paul Burstow: My hon. Friend makes a fair point—one that, I think, we would agree with entirely. That is why the Government published, for the first time ever, an outcomes framework for the NHS that is all about considering how clinical care leads to the sort of longer-term outcomes that he seeks, so I hope that that addresses his comments. That will be built into the way in which we go forward with drafting the regulations to reinforce that approach.
	On the stability of services, my hon. Friend has tabled amendments 1203 and 1204 and new clause 18, which link very closely to Opposition amendments 42 and 43 on the interdependency of services. My right hon. Friend the Secretary of State spoke to two similar amendments that my hon. Friend moved yesterday. We agree with hon. Members about the need to secure continued access to services for patients. We have introduced substantial new proposals to improve on our previous plans. However, I repeat what my right hon. Friend said yesterday: this is not about securing access to the same services in perpetuity. That has never been the case, and it should not be the case. Services evolve, and we must allow new providers—whether NHS, social enterprise or private sector—to come in where they can deliver high-quality care for patients.
	I shall turn now to excessive prescription and a number of issues that arise from several amendments, which would tilt the balance in a way that would turn the system much more into a command-and-control one than many hon. Members have argued that we should have for many a year. Amendment 1218 would break a fundamental principle at the heart of our proposals: that the membership of CCGs should consist solely of GPs, and that we should encourage, rather than prescribe, how they involve other professionals.
	Amendments 1237 and 1238 would remove the Secretary of State’s power to make transfer schemes for property, staff, rights and liabilities, thus making it less flexible to make transfers from, for example, a PCT to a CCG. I am well aware that many people feel that the ability to transfer staff in that way is an essential part of managing a smooth transition. Therefore, to deny the Secretary of State the ability to do that seems very odd. Amendment 1167 is unnecessary for the same reason. CCGs are different entities to PCTs, with different
	structures, duties and functions. It does not make sense to set a limit on the number of CCGs by comparison with PCTs.
	Opposition amendment 5 would delete clause 10, but Opposition new clause 14 would reinstate it. So it is a sort of hokey-cokey set of proposals, whereby a provision would be taken out and then put back in again. As the Bill includes a power to make regulations to take account of people in specific circumstances, new clause 14 and amendment 1178, which is consequential on it, are unnecessary.
	New clause 11 would require the NHS commissioning board to limit the administration spend of CCGs individually and collectively by comparison to 2009-10. In other words, it would set an arbitrary starting line and effectively lock the budgets that way. An absurd shackling of the NHS commissioning board or CCGs in that way belies common sense and sound financial governance.
	Amendment 1206 runs the inherent risks, as discussed in Committee, of trying to prescribe the setting allocations in legislation. I understand the concern expressed by my hon. Friend the Member for St Ives (Andrew George), and the White Paper made it clear that we want to ensure that access in every part of the country is fair and equitable. We will want to ensure that that is achieved, and I am happy to continue to discuss those issues with my hon. Friends.
	Amendment 1167 is unnecessary for the same reason. CCGs are different entities from PCTs, with different structures, duties and functions, and it would not make sense to set limits in such a way. The additional statutory provisions set out in new clause 10 are also unnecessary. Imposition of a minimum waiting time would not take account of the clinical needs of individual patients, and it is for clinicians to plan care on the basis of the clinical needs of patients and their right to access the best service.
	We are considering how best to prevent PCTs from imposing clinically inappropriate blanket minimum waiting times, but there are already sufficient powers in the Bill to address the issue when it comes to CCGs.
	Amendment 41 is also about consultation and transparency. We have already changed the Bill to enhance the duty on CCGs to involve and consult the public, but the commissioners must have sufficient flexibility to be proportionate in how they involve patients and service users. CCGs will not be able to use that flexibility to underplay their duty to involve the public.
	I want to discuss a section of the Bill that I know concerns some of my hon. Friends and which perhaps was not much discussed in Committee—public health. A number of amendments are relevant here. New clause 23 would create the role of a chief environmental health officer. The chief medical officer, however, is already able to provide the very advice that the new clause would establish a new role to provide. The chief medical officer can provide independent advice on environmental health issues. At a time of financial stringency, the new clause would create a layer of wasteful bureaucracy.
	Amendments 1253 to 1260 relate to the role of directors of public health. Our position is that they should be employed by the local authority to support local government in the new role that the Bill confers on local authorities in respect of public health.

Fiona O'Donnell: The Minister and the Government are fond of pausing with this Bill. I want to offer him the opportunity to pause as he comes near to the end of this long list of amendments and apologise to the many health organisations and patients organisations across the country for the anxiety and concern that he and his Ministers have caused.

Paul Burstow: I am sure that as people read the transcript of the debate they will wonder why that intervention came at this point, other than to make a cheap party point. It is one that many Members of the House will know has set the tone for much of the Labour party’s contribution to debate on the Bill.
	I was about to discuss an important issue, which is how we improve the health of our nation through our public health services. Returning to amendments 1253 to 1260 and the role of director of public health, we are having discussions about how best to ensure that the director of public health has an appropriate status within the local authority. There is concern about who directors report to and are accountable to. We intend to return to that matter once the consultations are concluded to make that absolutely clear, and to address those concerns.

Stephen Dorrell: Will my hon. Friend repeat the statements that were made in a Select Committee hearing about the status of directors of public health? Is it the Government’s view that, at the very least, they should encourage—and preferably make mandatory—the status of a director of public health as a senior officer of the local authority, not reporting through any other senior officer of the authority?

Paul Burstow: My right hon. Friend is right to remind the House of the clarifying statement that was made before his Select Committee. That is what we want to encourage. We are listening to the results of the consultation exercise at the moment. Such people should be officers who report to the council and to the chief executive. Those are the issues that we are considering, and we will return to the matter.
	Amendment 1254 would require the local authority to obtain the agreement of the Secretary of State before dismissing its director of public health. Our view is that as the local authority is the employer, it is not appropriate for the Secretary of State to intervene directly. The Bill already requires local authorities to consult the Secretary of State before dismissing a director of public health, so there is a safeguard already built into the legislation.
	Amendment 1256 would require the director of public health to be suitably qualified. It is important to be clear that, as the Bill sets out, the director of public health must be jointly appointed by the Secretary of State, who can ensure that only appropriately qualified individuals are appointed. The amendment is therefore unnecessary.
	Amendments 1255, 1258, 1259 and 1260 would either replace references to the Secretary of State with references to Public Health England or confer new duties on Public Health England. In legal terms, Public Health England and the Secretary of State are the same thing, and Public Health England will not be provided for in primary legislation. It will be an executive agency, which makes amendments 1255 and 1260 superfluous.
	Amendments 1258 and 1259 would effectively require the director of public health to be employed by the Secretary of State. There is, I believe, widespread support for conferring new public health functions on local government in this area. As there is widespread support for that, it follows that local government should have the appropriate expertise and resources, rather than what my right hon. Friend the Member for Charnwood (Mr Dorrell) described, and rather than having to rely on central Government or agency support.
	Amendments 1242 and 1243 would extend co-operation duties for local authorities when exercising public health functions. Local authorities already have a number of co-operation duties relating to health and well-being, and new health and well-being boards will encourage integration of health and social care. The amendments would simply complicate matters unnecessarily.
	Amendments 1172 and 1173 would give the Secretary of State a duty to make arrangements for facilitating haematopoietic stem cell transplantation. That is unnecessary, because of the continuing functions of the Secretary of State, which we consider very important indeed. Those are provided for under proposed new paragraph 7C of schedule 1 to the National Health Service Act 2006. The amendments are therefore unnecessary. I hope that that reassures my hon. Friend the Member for Enfield North (Nick de Bois), who tabled them.
	We are also making a range of technical amendments to these clauses, with which I will not detain the House. If Members wish to have further information about those matters, I should point out that they were the subject of detailed briefings published last week to accompany the amendments.

Owen Smith: I am grateful to the Minister for his contribution. Questions about the Bill just keep coming. That is how I feel on rising to speak. We have had eight months of debate on it. So far, more than 1,500 amendments have been tabled and we have learned today that more are coming, which was news to us at least. We have two—soon to be three—versions of the Bill, as well as a very real issue between Ministers and the Opposition over how it ought to be interpreted and what tone we ought to take when debating it. I would like to address some of those questions and talk about the tone. I also want to outline how we are interpreting the Bill and state that we feel very sincerely that the Government are misrepresenting what is in it.
	By way of illustration, I shall pick up on a few things that the Minister said, which I feel either raise further questions or misrepresent what is in the Bill. I want to discuss in particular the issue that was debated by him and my hon. Friend the Member for Warrington North (Helen Jones)—whether, under the aegis of the Bill, the meetings of CCGs are to be held in public. He was very clear about that. In fact, he was so clear that he had his Liberal Democrat friends bouncing up and down, shouting, “Must, must! They must meet in public. Haven’t you read the Bill?” He went on to suggest that my hon. Friend had perhaps read an earlier iteration of the Bill. I know her well enough to know that she does her homework and she will indeed have read the second version of the Bill. There have been so many that it is quite easy to lose track. She will also have read schedule 2 of that Bill, which states—I will quote directly; I will not just make it up, like the Minister—
	“The provision made under sub-paragraph (3) must include provisions for meetings of governing bodies to be open to the public, except where the consortium considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting.”
	Meetings will therefore be held in public unless the consortium decides on a whim that it is not in the public interest for the public to come to the meeting—that is, for the meeting to be held in public. That is the tone that Ministers have set throughout the Bill. It is misrepresentation. It relies on the fact that there are thousands of words, acres of clauses and endless amendments. Ministers are trying to bore people into failing to look at the details, but I am far too much of an anorak; I will keep reading the Bill, keep looking at the amendments and keep drawing them to the public’s attention.

Helen Jones: Does my hon. Friend agree that experience shows that when bodies are left to determine when it is in the public interest not to know what is going on, they usually do so on the basis of what would be embarrassing to them? Does he not fear that when difficult decisions are to be taken, commissioning groups will shut down public debate by making their meetings not open to the public?

Owen Smith: One needs to look at the top of institutions in this country—at the Government, and the extent to which Governments of all stripes choose what they are going to reveal to the public and what they deem not to be in the public interest. That standard is set and applied throughout public and private bodies in this country and elsewhere.
	I have no doubt that there will be many instances when CCGs will determine that it is not in the public interest that the public be admitted to their meetings—in particular, for example, when they are discussing hospital reconfigurations or closures, and changes to public services that people consider to be vital in those areas. CCGs must consider all those crucial issues, but they must do so in a transparent manner, which is what we said in Committee last time round, on the previous iteration of the Bill. We have said it again and the Government still have not answered the point to our satisfaction. I call upon the Minister to amend schedule 2 once more. There is time to do so in the other place and he may well want to give that consideration.

David Ward: As a shadow Minister, is the hon. Gentleman aware that there is a standard clause in the standing orders or constitution of every public body and every local authority throughout the country? It is for those bodies to justify what is in the public interest. That is standard in public sector organisations across the country. He is trying to make something out of nothing.

Owen Smith: No, I am trying to make a point about what the Minister said at the Dispatch Box not five minutes ago, which was that CCGs must meet in public. I am pointing out that that is not accurate. They do not always have to meet in public; they may choose not to. Whereas that may apply across the board in other public institutions, these are crucial new bodies about which there are grave concerns. We on the Opposition Benches are concerned to ensure that they should be obliged to meet in public on all occasions.

Paul Burstow: My hon. Friend the Member for Bradford East (Mr Ward) is right. That is why the outrage was expressed as it was. This part of the Bill and the schedule have the same effect as the Public Bodies (Admissions to Meetings) Act 1960. That Act does not say in a blanket way that every meeting must be held in public. It allows local authorities to exercise judgment about confidentiality. We are applying the same principles in that regard in exactly the same way as to PCTs, with the additional provision that for the first time all these arrangements must be published.

Owen Smith: I am grateful to the Minister for that further intervention, just as I assume that he is grateful for the intervention of the civil servants in the Box, who must have passed him a note. Clearly, he was not aware of that earlier. When he said that CCGs must meet in public, he was under the impression that that was the case.

Nicky Morgan: Will the hon. Gentleman give way?

Owen Smith: No. I shall move on now. We have debated the topic long enough.

Andrew Gwynne: My hon. Friend is right to be concerned about the way this part of the Bill is drafted. It is incredibly open-ended for the consortium to decide what is exempt from public knowledge. That is quite different from the situation in local government in England, where Local Government Act 1972 prescribes what is exempt from the press and the public.

Owen Smith: Indeed. The key difference is that it is for the clinical commissioning groups, in establishing their constitution, to determine what the rationale will be for allowing the public in or not. That is not set down in statute or in direction from the Minister or the Secretary of State. It is for individual CCGs to determine when they should let the public in. I give way to my colleague on the Bill Committee.

Nicky Morgan: I am grateful to the hon. Gentleman. I remember discussing with him whether he was a lawyer, and he was proud to say that by background he was not a lawyer. As he knows, there will be occasions when a clinical commissioning group is considering a matter which is sub judice. It could be an employment law matter; it could be a confidential matter relating to a patient—for example, a mental health patient for whom there has been very sensitive care. There will be times when it is appropriate and in the public interest and that of relatives—[Interruption.] I am making the point to the hon. Gentleman, not to those on the Opposition Back Benches. There will be occasions when it is appropriate for the CCG not to meet in public, as I am sure he will concede as a matter of common sense.

Owen Smith: I will not dispute that there may be occasions when it will be appropriate for the CCG to meet in private, but that is not what the Minister said. My point was to do with the tone and the misrepresentation that has been systematically applied by those on the Government Benches. That is the difference.

Sarah Wollaston: rose—

Owen Smith: I shall not give way any more on that issue. [Interruption.] I was enjoying it too, although I would be surprised if the Minister was. I shall move on, if I may, to questions. As I said, there are many questions.
	The Minister said today with his usual candour and clarity that the vast bulk of health care will in future be delivered by NHS services. That is a new one on me—“the vast bulk of health care”. That raises two questions. Will he characterise what he means by “the vast bulk”, and what he means by “NHS services”? In a world in which we will have a much more mixed economy, with a much greater mix of public and private providers working under the banner of the NHS, it is far from clear whether those things will be provided through what we have understood traditionally to be a public NHS or through some new hybrid NHS that the Minister is cooking up in the laboratory at the Department of Health.
	The Minister said a moment ago that there were many amendments. He is a master of understatement, as ever. There are about 100 amendments in the first group, and a further 100 or so to be debated later today—part of the 1,000 amendments that have, extraordinarily, been tabled at this stage of the Bill, eight months after it first appeared.
	I will consider the amendments in three broad groups. The first group relates to the duties of the Secretary of State. The second group relates to the creation of the national commissioning board and the clinical commissioning groups, and the consequent disaggregation, or break-up, of the hitherto integrated and collaborative national health service, which is what we believe will happen. The third group encompasses the important issues relating to the cost of the envisaged Government actions for NHS staff, for their education and training and for their terms and conditions.
	In addressing all those things, as the Minister keeps telling us and as I have repeated, tone is very important. The Opposition have repeatedly been accused of scaremongering and misrepresenting the Bill in a cynical fashion. Is the Minister seriously saying that all the people who have criticised the Government and levelled accusations that this is a damaging Bill are scaremongering, because it is not just the Labour party? [ Interruption. ] The Minister says from a sedentary position that he did not use the word “scaremongering”. His colleague, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), used that word on three separate occasions yesterday, and I have noted the Secretary of State use it on several occasions. I have no doubt that, were I to read the Hansard reports of the Bill Committee’s sittings, I would find that the Minister had used the word, because it has been very popular on the Government side of the House.
	The word “scaremongering” is popular, because it is what the Government think we are doing. [ Interruption. ] The Secretary of State says that we are, so perhaps he will get up and tell us whether the British Medical Association, the Royal College of General Practitioners, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Psychiatrists, the Chartered Society of Physiotherapy, the Royal Pharmaceutical Society, the British Association of Occupational Therapists and the Association of Medical Research Charities—the
	alphabet soup of medical organisations that have criticised the Bill—are all scaremongering? Do they all misunderstand the Bill?
	[
	Interruption.
	]
	He is not just talking about us, because in many instances we are raising the same concerns that those groups have raised both in detail and in broad terms.
	I want to start—I have not even got rolling yet—by stating in the strongest possible terms that it is the Government who are being cynical in systematically obscuring the true intentions of the Bill and misrepresenting our profound concerns, because there is nothing hyperbolic or synthetic about them. They are very real concerns. We feel that the NHS, as a national, universal, publicly controlled and publicly financed institution is jeopardised by the Government’s proposed reforms. Not tomorrow maybe, or next year, but eventually and gradually it will be jeopardised by the new laissez-faire, localised, commercially driven and legally contestable version of the NHS. [ Interruption. ] The Minister sighs, but all those things are precisely what the new system is about. The matter will be tested in the courts, and the first things that we will test are the duties of the Secretary of State.
	We feel that progressively the national, strategic and equity-driven system that we have had in the past 60 years in this country will be undermined. Worst of all, we feel that wider society, because of the obfuscation carried out by the Minister, will only really spot it when it is too late. We will only really miss the NHS, as we have known it, when it is gone. It is particularly ironic that, at a point when many people in the House and elsewhere are thinking about what binds our society together and what are the things we want to nurture, how we bring about a sense of community, collectivism and mutual support, as well as self-reliance, one of the institutions that is the shining example in our society of all those values is being so profoundly undermined by the Government. Is that scaremongering? I do not think that it is. I do not think that we need to rely on our words or those in the medical profession who have criticised it. We can rely on the words of the Government, because they have been very clear about their intentions. They stated in the White Paper:
	“Our aim is to free up provision of healthcare, so that in most sectors of care… effective competition stimulates innovation and… increases productivity within a… market.”
	As the Minister of State put it on TV, “We want a genuine market.” As the Secretary of State put it, “I believe it would be right for us to have price competition.” He has changed his mind about that, just as the Government have been forced to change their mind about a lot of things, but nevertheless I think that it is legitimate for us to point to those as reasons for being deeply concerned about the trajectory of the Bill.
	The Minister opened his remarks by talking about the duties of the Secretary of State, which I will move on to now because they are absolutely critical to the debate. We believe that the changes to the Bill, even in its third iteration, will fundamentally diminish the political accountability of the Secretary of State. As with the competition issue, the critical change is one that has been profoundly contested by the Government, but we think it is very clear. With respect to the changes introduced after the pause, we think the Bill still places at one very large step removed from the Secretary of State the fundamental duty to provide or secure the
	provision of health services in England, removing the duty that was placed on the Secretary of State by the National Health Service Act 2006, the National Health Service Act 1977 and all NHS Acts since 1946.
	Initially, the Government were not at all coy about that; they were absolutely up-front about wanting to remove political micro-management, as they kept putting it, from the NHS. In the White Paper, they said:
	“The Government will liberate the NHS from excessive…political control”.

Paul Burstow: Is it still the Opposition’s policy to seek a division between the role of commissioning or purchasing health services and the provision of those services? Does the hon. Gentleman believe in that split?

Owen Smith: Yes. The current situation is clear: the Secretary of State has a legal duty placed upon him in the legislation to secure and provide—not just to promote—a comprehensive health service in this country, and to issue direction to PCTs and SHAs, such that they so do. Those two crucial aspects of the current legislation are being changed in the Bill, and I intend to discuss them in a moment.
	In version 1 of the Bill, the Government were less coy, because it actually excised section 1 of the original 1977 Act. After the deluge of criticism, however, they decided that they needed to put it back in, making it explicit, as they put it, that the Secretary of State will be responsible, as now, for promoting a “comprehensive health service”.
	Section 1 of the Act was duly reinstated, as was the duty to promote, but there was a critical change, in clause 1(2) of the new Bill, which diluted the traditional duty to provide and secure. Ultimately, it placed a duty on the Secretary of State only to
	“exercise the functions conferred by the Act so as to secure that services are provided”.
	I shall come on to the reason why that is significant, but equally significant and allied to it was the retention—against the advice of Opposition Members and many others—of clause 10, which amends section 3 of the 2006 Act, thus keeping commissioning bodies, not the Secretary of State, as the parties with a legal duty to provide health care in England.
	The net effect of those changes—despite what the Minister said earlier, and despite what the Secretary of State has said on several occasions, including notably on Second Reading—is no change. The Secretary of State is still, as the Minister put it, washing his hands by divesting himself not of the NHS but of a direct duty to provide a comprehensive health service. That is the distinction which the Minister failed to make today. The Secretary of State is palming off that precious duty, which has been placed upon successive Secretaries of State, and handing it on, via the mandate, to a quango and to unelected commissioning bodies.

Andrew Lansley: If the shadow Minister is so concerned about the Secretary of State’s legal ability directly to provide services, will he answer me a question? Does he know the last time the Secretary of State for Health actually directly provided any services? In the Department of Health, we cannot find out when it was.

Owen Smith: With the greatest respect to the Secretary of State, who I have to confess knows a lot about the NHS and about the health service in this country, I think that that question is completely erroneous—a total red herring. As I said earlier, the practical reality is that the Secretary of State delegates—[ Interruption. ] No, no, no. The Secretary of State delegates to PCTs and SHAs his powers to provide, but, as I am going to tell the Secretary of State, he will know that under the aegis of this new Bill he will not have the power to direct clinical commissioning groups to do what he says, so he will not have a direct personal duty to provide. On the courts, we heard another interesting thing earlier from the Minister of State. He said that it was okay, because the Secretary of State will be able to justify in court when he directs a CCG to act. That is very important, and I am keen to hear the Secretary of State’s response to it, but I do not think that he has one that will convince us.

Andrew Lansley: The hon. Gentleman has admitted that for decades the Secretary of State has not directly provided services, and I know that that is true. The issue is about having a legal duty not to provide services, but to secure the provision of services. He admits that that is done through delegation, which is in the structure of the Bill through the delegation of that responsibility to the national health service commissioning board and the CCGs. The mandate, which my hon. Friend the Minister has clearly explained, is much more transparent and accountable to Parliament for the manner in which the Secretary of State secures the discharge of those duties.

Owen Smith: With respect, there is not a legal duty on the Secretary of State to provide, as there has been in successive health Bills. When Bevan talked about hearing the bedpan dropped on the ward in Tredegar, he did not mean that he wanted to pick it up. [Interruption.] I do not know whether the Secretary of State wants to listen. Bevan did not mean that it needed to be picked up by the Secretary of State, but he certainly meant that he would like to be able to direct those responsible operationally for picking it up so to do.
	The critical difference in this Bill is that the Secretary of State will divest himself of not only the duty to provide that service, but the power to direct the operational parts of the NHS, save for—[Interruption.] The Minister is waving his head, nodding or something; I know what he is going to say. Under the Bill, save for in cases of crisis or emergency, the Secretary of State will not have responsibility for running the day-to-day operations of the NHS.

Paul Burstow: The hon. Gentleman is wrong again. Unlike the previous Government, who were happy to have directions that did not have any parliamentary accountability, this Government are putting in place the ability, through regulations, to set the standing rules for the NHS, which, as set out clearly in clause 17, include all the issues that the hon. Gentleman is concerned about and show that the Government are committed to ensuring that there is a comprehensive health service.

Owen Smith: As the Minister has just confirmed by omission, there will be no power to direct and therefore no power to deliver absolutely a comprehensive, universal health service as we have come to expect and understand it. Those are the key differences. [Interruption.] The
	Minister can shake his head, but that is an accurate interpretation of what has happened.

Rosie Cooper: My hon. Friend has been talking about mandates. Will he explain under what mandate and how the Secretary of State is implementing all these structural changes? The House has not voted on them and the process started before the Bill came to the House. You are making structural changes, damaging the health service and making it impossible—

Lindsay Hoyle: Order. I am sure that the hon. Lady will not be using “you”.

Rosie Cooper: Forgive me. I am for ever doing that, and I must stop. In essence, I am saying that the Secretary of State and Ministers keep talking about mandates and what they will and will not do, yet they are disregarding everything because they are implementing the Bill before it has been sanctioned by the House or the other place.

Owen Smith: I am grateful to my hon. Friend for that intervention. As she will know, the Government have no mandate for any of these things—they were not in the manifesto, the election or the coalition agreement. There is a mandate, but not one to effect these sorts of changes. That is another disgrace given how large the changes are.
	I am going to move off this issue, but I will conclude by reading back to the Government their own words, which make it absolutely clear what they are doing in getting rid of direction. Paragraph 66 of the explanatory notes states:
	“Currently, the Secretary of State is directly responsible for providing or securing the provision of all health services as set out in the NHS Act, a function which is largely delegated to Strategic Health Authorities and Primary Care Trusts…However, the new commissioning structure proposed by the Bill means that this would no longer be the case.”
	The explanatory notes also state that
	“functions in relation to the health service are conferred directly on the organisations responsible for exercising them”.
	Effectively, the Secretary of State will move on and his focus will shift to public health.

Paul Burstow: I want to be absolutely clear about this. The hon. Gentleman is happy with an arrangement that allows the Secretary of State to make directions to the NHS that do not require him to come to this House to account for his actions—is that correct?

Owen Smith: I am happy—we are happy—with the Secretary of State being properly, publicly accountable through this House and having a legal duty placed on him to secure and provide politically accountable health services in this country. We are deeply concerned that the changes envisaged in the Bill, which radically alter the nature of the NHS, will not be able to be held to account through the Secretary of State in future Parliaments. That is our profound concern about the line of direct political accountability that so many of the Minister’s hon. Friends share, which is why they have tabled amendments to that effect and why they have repeatedly raised these
	concerns in the Bill Committee and elsewhere. The Minister does not have those concerns, but many other Liberal Democrats do.

Andrew George: I have to say that I entirely respect my hon. Friend the Minister. The hon. Gentleman’s point echoes what I said earlier in contradicting the Department of Health’s claim that the original 1946 Act did not have a requirement to provide or secure services. My quote provided evidence that that requirement has always been there. The Department also claims that because of the changes it is no longer legally acceptable for the Secretary of State to have that responsibility, but that issue has not been properly addressed. Would the hon. Gentleman care to deal with the point that it may no longer be legally acceptable for the Secretary of State to have that duty?

Owen Smith: As I said earlier, or rather as somebody said on my behalf, I am not a lawyer—I am a historian. As a historian, I agree with the hon. Gentleman that the 1946 Act does indeed say:
	“provide or secure the effective provision of services”.
	He was entirely right in that, and I could not understand the response from the Minister.
	The key thing is that eight months, two Bills and 1,500 amendments later, we are still debating clause 1 and its legal interpretation. That is testament to just how badly botched this Bill has been and just how alarming it is for many people—patients and NHS staff—that we, the legislature, do not understand, or have divided views about, our understanding of the critical responsibility of the Secretary of State.

Stephen McCabe: Before my hon. Friend moves on to the next section of his speech, perhaps I can return to the question of a mandate. Given that this is such a botched Bill, given what he says about the tone of the proceedings, given that at this stage nobody seems to understand exactly what are the implications of some of the Government’s claims, given the fact that the Government are not willing to entertain people’s legitimate concerns, and given that there is no mandate in either Government party’s manifesto for this Bill, the other place is presumably not bound by the Salisbury convention, and if the Government will not entertain those concerns here, it will be the duty of the other place to address them.

Owen Smith: It will. I have no doubt that the very many lawyers in the other place will have a field day in addressing these issues—just as, we fear, lawyers the length and breadth of this land will have a field day, not only during the passage of the Bill but for many years to come. That is because so many things will be contested, not only relating to the issues we are debating but, far more importantly, in relation to competition, which we debated yesterday, where it is undoubtedly the case that decisions that have hitherto been made to provide services from within the family of the NHS will be challenged by carpetbaggers—profit seekers—from outwith the NHS. Under the future provisions, those issues will need to be tested in the courts. The Government have conceded that on several occasions, and I am sure that they would do so today if they were asked.
	Finally on the issue of the Secretary of State, and once again to hammer home the point that this is not just Labour scaremongering and that lawyers will be involved at every step of the way, I draw Members’ attention to the independent legal opinion that was provided by Stephen Cragg QC. Paragraph 1 of the executive summary states:
	“It is clear that the drafters of the Health and Social Care Bill intend that the functions of the Secretary of State in relation to the NHS in England are to be greatly curtailed.”
	It goes on:
	“Effectively, the duty to provide a national health service would be lost if the Bill becomes law. It would be replaced by a duty on an unknown number of commissioning consortia with only a duty to make or arrange provision for that section of the population for which it is responsible.”
	It states that the Bill is
	“fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate.”
	That was the view of an independent QC on reading the Bill. It is a view that I and the Opposition share. I suggest that Ministers read it very carefully and do not dismiss it, as they have done today, as an inaccurate reading of the Bill.

Nicky Morgan: Is that the independent legal advice given to the campaign organisation, 38 Degrees? If it is and if the hon. Gentleman has any influence over that group, can he persuade it to release and make public the instructions given to counsel, because any instructing solicitor who instructs counsel to give advice usually gives very clear guidelines on, or an indication of, what they want the advice to say?

Owen Smith: I am ever so grateful to the hon. Lady for that intervention, because it is profoundly rich for anybody on the Government Benches to suggest that we should prevail upon an independent organisation to publish the instructions that it offered to an independent QC, when the Government will not even publish the independent advice that they have commissioned. They have refused to do so repeatedly. They will tell us that they do not agree with this independent opinion, but they absolutely will not publish their own. I suggest that she makes representations to those on her Front Bench, and I will do the same to 38 Degrees if I have a chance.
	The independent legal advice goes on to say:
	“Encouraged by the structure and clear intention of the Bill to give consortia autonomy from the Secretary of State,”—
	which is, of course, in clause 4 of the new Bill—
	“there is a real risk of an increase in the ‘postcode lottery’ nature of the delivery of some services, depending on the decisions made by consortia.”
	That increase in the postcode lottery takes me on to the second set of proposals that I wish to touch on, which we believe would stop the Government effectively legislating to hardwire the postcode lottery into our NHS. We accept that it is already too variable across the country and that there needs to be greater equity and standardisation, with excellence provided to everybody across the country. That will become all the more difficult with the new provisions.
	New clauses 10 and 11, which were tabled by the Labour Opposition, are designed to combat some of the possible malign consequences of the changes that
	hand to clinical commissioning groups the ability to determine the needs of the local health population and to set their priorities without interference or support from the Government, or indeed from regional strategic health authorities.

Daniel Poulter: rose—

Owen Smith: I am delighted to give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who has such an acute interest in Wales.

Daniel Poulter: The hon. Gentleman is making some good points. Does he accept that within a national framework of gold standard and good treatment, there will be regional or local variations in the needs of patient groups? For example, given health care inequalities, mental health and the higher rates of cardiovascular problems in ethnic minority populations, patients in Bradford may have very different health care needs and priorities than patients in the area of rural Suffolk that I represent. Does he agree that the Bill goes some way towards allowing local flexibility that will better address some of the different local health care needs?

Owen Smith: I accept that there are obviously different needs and that there is a good case for a needs-based assessment model being used by PCTs in the current situation or by CCGs. Indeed, one of the amendments tabled by Liberal Democrat Members on a needs-based assessment is excellent and I wish that we had tabled it. However, the crucial difference, which I alluded to earlier, is that previously the Secretary of State has had a direct duty under section 3 of the National Health Service Act 2006 to provide and secure a whole range of relevant and necessary pieces of the health ecosystem, such as hospitals, within a given area. Under the Bill, that duty will pass to clinical commissioning groups. That is a further crucial removal of responsibility and accountability from the Secretary of State and transference of them to CCGs.
	Under the aegis of the Bill, many CCGs may well plan well for their local population, and perhaps better than primary care trusts, but what if they do not? What if they get it wrong and determine for clinical reasons—or, dare I say it, because in this new world they are sitting cheek by jowl in the boardroom with commercial players who have a stake and a skin in the game financially—that they no longer feel it is “reasonable”, as the Bill puts it, to provide certain services? I think that is perfectly foreseeable.
	We already know that because of the cost pressures that PCTs are under, they are having to make difficult decisions about which services they will provide and which they will not. They have always had to do that. It is just possible that CCGs will make duff decisions with which local residents disagree. As we heard earlier from my hon. Friends on the Back Benches, they will not be able to be held to account in the way that the Secretary of State, and eventually PCTs through the Secretary of State, can currently be. Those changes are critical, and I suggest that the Minister reflects on them.
	Another crucial change to the Bill that we would like to be brought about is in respect of the costs of bureaucracy. We are changing from 150 PCTs to more than 250 clinical commissioning groups and counting. The latter are smaller and less strategic, and certainly
	less experienced in commissioning, than PCTs or strategic health authorities, and they are arguably too small to compete equitably with very large and financially powerful foundation trusts. That is a real risk. Crucially, they will also increase transaction costs, bureaucracy and administration costs.
	That is why, in new clause 11, we have decided to ask the Government to put their money where their mouth is. The Minister asked earlier why we had chosen an “arbitrary” figure of 45% for a cap on the volume of expenditure on administration by CCGs. The answer is simple: it was the number that the Secretary of State came up with. He said that that was how many percentage points he was going to trim off the administration and bureaucracy costs of the NHS. He boasted that he could deliver 45% savings, so we are calling on him today to put his money where his mouth is and legislate for that. Let us measure him against that, because there is not going to be much else that we can hold him accountable for.
	We have tabled new clause 10, on waiting times, because targets and standards absolutely matter in the NHS. No matter what the Government keep telling the public, we still believe in clinical targets, including some that the Government would denigrate as “bureaucratic” or “administrative” targets. In new clause 10, we ask the Government to take the power to set transparent regulations relating to waiting times. Waiting times are going up under this Government. There have been 400,000 people with long waits since the Tories came to power. The trajectory and the sense of history repeating itself are depressingly clear to me and my hon. Friends.

David Tredinnick: I think the hon. Gentleman might inadvertently have misled the House. He said that waiting lists were going up in the NHS. My recollection is that they are going up in Wales. He is shadow Wales Minister, I think.

Owen Smith: I was waiting for that intervention and looking forward to it. I was slightly concerned, when the hon. Member for Central Suffolk and North Ipswich intervened and failed to mention the fair and beautiful country of Wales, that I was not going to get the opportunity to put the record straight. I hate to tell the hon. Member for Bosworth (David Tredinnick) this, but he is wrong. Waiting lists in Wales are coming down. We have been hitting 95% of our target week in, week out, month in, month out since September 2009.
	I will concede that the Labour Government in Wales had a problem with orthopaedic waiting lists because of a lack of capacity and too few orthopaedic surgeons, but they invested an additional £65 million to deal with orthopaedic waiting times. I am confident that that will have an effect, but the key is that we still have and observe waiting targets in Wales, and we expect that people will holds us to account in hitting them, whereas in England we are getting rid of waiting targets. What is happening as a result? Waiting times are going up, as happens every time the Tories come to power.
	We have also seen from the Co-operation and Competition Panel, which the Government are keen to pray in aid on other matters, that minimum wait times are now being set by PCTs in England in anticipation of
	the increased autonomy that they will have. They are already deciding they will carve out their budgets and curb costs by setting minimum waiting times, and by introducing independently determined—not NICE-determined—clinical thresholds for treatment. Those things are entirely unacceptable, as the Secretary of State conceded in a letter to my right hon. Friend the shadow Health Secretary. However, they are symptomatic of what we will see in a busted-up, fragmented and disaggregated NHS. Without strategic regional oversight, local decision making will compound the postcode lottery.
	New clause 14 is an important proposal. It is designed to prevent those who shout the loudest under the new fragmented system from gaining the most, and from gaining an inequitable share of health care resources. That has been a traditional concern of health care policy under different Governments, and it remains a concern of the Opposition.
	The Bill makes commissioning bodies—CCGs—responsible for both the people on their practice lists and people living within their boundary area who are not on the practice list of another CCG. The Opposition have argued against that for two key reasons. First, as Liberal Democrat Members will recognise, the measure makes population-based needs assessment impossible. That kind of structure means that totting up potential customers and patients within an area cannot be done, because they will not live in a single, defined area. Some people who do not live in the area might need to be covered because they are on the list, and others will not need to be covered even though they live in the area. Secondly, the Opposition are against the kind of system in which the most vocal and well informed, and perhaps the wealthiest, can shop around for the best GP practice, and therefore the best consortium, which could be outside their immediate area.
	New clause 14, alongside amendment 5, which would delete clause 10, would make the people in the area of a CCG its primary responsibility. Regulations would allow CCGs provision for other people, such as those on their practice lists, but they would always remain responsible for the people in their area.
	Education and training is another crucial measure in the Bill that we are shoehorning into this very short debate—it is perhaps one of the greatest concerns of the medical fraternity. We have tabled several proposals on that: new clauses 12 and 13, amendments 7 and 47. On staff terms and conditions, we have tabled amendment 1168. In addition to providing the strategic, regional tier of NHS government, SHAs have a key role in education and training, including, crucially, hosting deaneries and in work force planning. Those are obviously linked to questions of emergent innovation, changing need in a local area, and any potential consequent reconfigurations of hospitals. They are absolutely central to how we run the NHS and plan for its future.
	It is therefore scandalous that we come to this juncture, many months after we started our debates on the Bill, with SHAs—the repositories of the training and planning function in the NHS—on the verge of being abolished. Their abolition has shifted from seven months to around 14 months, but in legislative terms SHAs are on the verge of being done in by the Government. However, the Government have absolutely no idea what they will replace the education and training facilities with—and
	the Minister has had the temerity to come to the House today and inform us that a new amendment is to be tabled in the House of Lords to deal with this crucial part of the Bill.

Paul Burstow: I have said that before.

Owen Smith: The Minister has not said it before in a public realm of which I am aware. He certainly did not say it in the Public Bill Committee, all 40-odd sessions of which I feel I sat through. The Minister knows that the issue is crucial, because the Future Forum that he commissioned said so. Indeed, it said that
	“one of the most widely voiced criticisms of the proposed changes was a deeply felt concern at the risks to healthcare education and training in England posed by the fast pace of change.”
	The Government responded by saying:
	“we will introduce an explicit duty for the Secretary of State to maintain a system for professional education and training as part of the comprehensive health service.”
	We are still waiting. What will that duty look like? [Interruption.] The Minister says “We have said that we are going to do it”, but here we are, eight months and 1,500 amendments later. How long must we wait? Are we sure that we will see the duty introduced in the House of Lords? Are we positive about that? I must say that I am not certain about it.

Paul Burstow: The shadow Minister rarely criticises the Government for telling the House again what they said in the response to the Future Forum, which is that we would introduce that explicit duty. We will introduce it in the House of Lords, as I have told the House today. We are committed to doing so, having listened carefully to the concerns of NHS professionals.

Owen Smith: The very simple question to be asked is “Why the delay?” Why could the Minister not have introduced it earlier? We have known about the problem for eight months and more. The Secretary of State, who has been keen on changes such as this for a long time, must have given some thought to what he was going to do about staff training and work force planning in the NHS.

Kevin Barron: It was clear from the day of its publication that the Bill, which abolishes the structure that had kept education and training in place, would create chaos in the national health service. Here we are, hundreds of amendments later, with a resubmitted Bill. Our debate on the outcome has been crammed into two days, which is wholly unsatisfactory, and the Government still cannot tell us what will replace the structure that has been in place for so many years. That is a nonsense.
	I listened to the Minister’s speech earlier. He was telling people—people outside, including professionals who want this kind of professional development on a continuing basis—to have faith in what might happen at some stage. I have to say that I have little faith in what the Government have done with the Bill from the very beginning.

Owen Smith: I entirely agree, and my faith is diminishing by the minute. I do not understand why the Government cannot simply concede that they have signally failed to deal with this crucial aspect of the Bill. It took them months to produce the revised failure regime. They managed to drag that out in time for Report, but they
	have not produced the impact assessment, they have not produced any figures showing how much this will cost the public purse, although we know that the amount is rising—I should love the Minister to tell us by how much—and they have not produced a solution to the crucial problem of staff training and work force planning. That is a disgrace. They could have and should have done it by now.
	New clause 13 would place a further duty on providers, related to what is in the earlier new clause. It would oblige them to make provision for training and work force planning for their own staff, thus filling another gaping hole in the Bill. As the Minister might say if he intervened on me, Monitor may well have powers, under the pricing clauses, to pay less under the tariff to providers who do not engage in training, but nothing in the Bill compels new entrants—especially private providers—to give their staff any training, or to deal with any costs that the NHS has traditionally had to bear for the education of the work force.
	We all know that in the incredibly fast-moving and innovative world of health care, keeping staff up to date is absolutely crucial. That is why—I hate to say it—despite the news that we are to have an amendment ín the Lords, we will attempt to press amendment 7 to a vote. It proposes the retention of SHAs until and unless we know precisely what the Government will put in their place in respect of training and administration.
	NHS staff is another group that is profoundly concerned by the shambles, chaos and confusion that Ministers have overseen. Under the Bill, they are described as assets and will be transferred lock, stock and barrel between new providers. The new providers may be a private company—such as Helios, Bupa, UnitedHealth, or whoever else decides it is interested in running the NHS in future—and the staff may be transferred to the new providers. The Minister shrugs, suggesting that that is a misrepresentation, so I challenge him to intervene on me and state what he seemed to imply earlier: that what I have just said is not the case.
	Schedule 23 makes that explicit, however. It provides for the transfer of NHS staff and other assets. It allows such so-called assets to be passed in future from NHS entities to the new CCGs. That can happen to any
	“person who provides services as part of the health service in England and consents to the transfer”.
	Under schedule 23, any NHS member of staff—or a building or intellectual property—can, so long as they agree, be transferred to anybody else who is licensed to provide services to the NHS. I find that extraordinary, but not quite as extraordinary as the next provision, which refers to NHS bodies being able to transfer all such assets—what a delightful way to refer to people—to a “qualifying company”, whatever that means. I will be delighted if the Minister tells us what the term “qualifying company” in schedule 23 means.

Alison Seabeck: Does my hon. Friend join me in sharing the concerns of many public health consultants in this regard? They sometimes cover three areas of work, so in one area they could go to the commissioning board, in another they could go to children’s health commissioning, and in another area of their job they could go to the local authority. What are those people supposed to do? I suspect some of them will leave the service.

Owen Smith: My hon. Friend is close to health workers and health professionals in her constituency, and she knows that people are leaving the service in droves. It is not just managers who will be sacked from primary care trusts or transferred across to they do not know what kind of organisation elsewhere. Clinicians are also deciding that they no longer think the job is worth the candle, because of the endless top-down reorganisation—something we were told we would not see from this Government, although it just keeps on coming. I fear that the situation will get worse in coming months. We will have to wait and see what the capacity of these new CCGs—and, potentially, the national commissioning board—will be, because we do not yet know who will be left standing at the end of this endless round of changes.
	In summary—[Interruption.] It is a long summary, and if hon. Members keep talking it will get longer. In summary, we have had eight months of debate in this place, two—and soon to be three—versions of the Bill, with 1,500 amendments, hundreds of protest meetings across the country, and 450,000 signatories to a petition trying to “kill the Bill”. Those extraordinarily high numbers are a reflection of the importance of the NHS to the British people, to the NHS workers and to us, the Labour party.
	For many in our society the NHS remains the shining symbol of the civilised collectivist values that first informed its creation 60 years ago, and they rightly view its continuation and their stake in it as part of their British birthright. We in the Labour party view it as a cherished part of our heritage. It also shines a light for us to the future, and we will not stand by and let how we have known it to be for these past 60 years fall into the pages of history. In 1946 we legislated to realise the vision of a collaborative and comprehensive national and public service, as part of the essential glue of that post-war society. This Bill promises instead to give birth to a denationalised NHS—a denatured NHS—divided by competition law, and conquered by profit seekers and carpetbaggers from across the globe.
	Ministers, especially the Secretary of State, should remember that it is never too late to change one’s mind—it is never too late to save the NHS. We are appealing for them to do so and they would do well to do so. They should remember, too, the dire and, I trust, accurate prediction and warning given by the man who was proud to be the midwife to the NHS—the Welshman, Nye Bevan—in 1946. He said that
	“no government that attempts to destroy the Health Service can hope to command the support of the British people.”
	That was true when he wrote it in 1951 and it will be true in 2015 when the Prime Minister asks the people to trust him on the NHS. I hate to tell the Secretary of State and, indeed, the Prime Minister this, but no amount of Ashcroft-funded airbrushed billboards pleading with people to trust the Tories on the NHS will count, because the evidence of their perfidy is written in black and white throughout this Bill, and it will be remembered at the next election.

Guy Opperman: I wish to start by making it clear that I am a big supporter of the NHS. I probably should declare an interest, because I have spent too much of the past six months discovering it from the inside. As is commonly known, I had a brain
	tumour in April, which was removed by the national hospital for neurology and neurosurgery in Queen square, where I received outstanding care and treatment from the doctors and nurses.
	That was not the first time that I had had my life saved by the NHS. Although my girth would deceive hon. Members, I used to be a jockey, and when I was trying to win a race at Stratford, the second last fence proved too much for the horse and me, we turned over and on my left hand side I was entirely crushed by a steeplechaser. I broke about 11 bones and cut my left kidney in half. I had a splenectomy and a very good doctor at Warwick hospital saved my life. I also wish to make the point that I have an NHS background: my grandmother was a matron in a district hospital, and we have spent an awful lot of time in the Hexham constituency supporting the Hexham hospital and the Freeman hospital, in particular.
	I support the Bill, and I wish to touch on a couple of the points that have been raised. For a time I earned a living as a barrister, reviewing health care bodies and public bodies of a general nature. I hope that that qualifies me to discuss competition law briefly. If hon. Members were to read, as I have had to over the past few months, some of the representations that have been made about competition, they would believe that it is a new evil being introduced into the NHS. However, that is manifestly wrong, as the Enterprise Act 2002 and the Competition Act 1998 were introduced under the previous Government and have been operating in the health service for a considerable time. I see some hon. Members shaking their heads, but the argument supported by the shadow Minister cites that exact point: in the form of a variety of institutions and undertakings, the UK health service is subject to competition law under the 2002 Act, the 1998 Act and European community laws on competition. This is therefore not a new thing, nor should it be, because it was introduced by the previous Government and large parts of the Bill follow on from what was done previously.
	I shall touch briefly on procurement, because the issue has been raised in this House. It is not a new thing for procurement matters to be challenged or to be subject to judicial process. Judicial process itself is not a bad thing. I have heard people say countless times in these past two days of debate, “This is going to be a den of iniquity for lawyers. It will be so bad that there will be lawyers all over this case. It will be really difficult for people to proceed with the health system.” I brought a case against a primary care trust in 2005, 2006 and 2007, with a view to trying to change the law and the way in which that PCT was operating. Before anyone jumps up to discuss that approach, I am pleased to say, first, that we changed the law to assist the patients, secondly, that the whole case was conducted entirely pro bono—for free—and thirdly, that two separate Labour Attorney-Generals gave me national awards to support my efforts. I do not expect that to happen again in a hurry. The point is that if we operate the process correctly—I shall talk about the process briefly in a second—we, and the commissioning consortia, will not be the subject of legal challenge.
	That will always be the case with any public body: if it operates in a statutory and well-authorised way and provides the degree of consultation that it should, it is
	not open to challenge. It is not myself or the Government who would decide that, but a High Court judge considering a matter of judicial review. But if the public body—in the form of the NHS or the commissioning consortia—does not act properly, behaves beyond its powers or breaches natural justice in any way, it should and will be open to judicial review and other legal process. That is entirely proper.
	I therefore do not believe that this will be a process through which huge numbers of judicial reviews will arise, as new issues for the NHS. I do not think that that will be the case at this stage. The hon. Member for Pontypridd (Owen Smith) talked at great length about the commissioned barrister’s opinion and 38 Degrees, but that barrister’s opinion makes the simple point:
	“The Bill does nothing to make the system more amenable to challenge in the courts”.
	Let me finish my points about competition and the duty to provide. I suggest that there is no fundamental change whatsoever. That is also the suggestion that the individual counsel made clear. I make the point that he is a junior counsel, not a Queen’s counsel, and there is no disclosure of instructions, the conference notes or any of the other things that would be vital to an understanding of the opinion. It has been wholly misrepresented by 38 Degrees, and there is no change—

Owen Smith: rose —

Guy Opperman: I am sorry, but I am going to keep going. The hon. Gentleman had about an hour to talk, and there are an awful lot of people who would like to talk about these matters.
	I suggest that there is no fundamental change, and this is clearly a way forward that is being implemented for the benefit of patients. We are concerned with patient care and the quality of outcomes. I as a patient, and many other people in this House, are not concerned with the quality of outcomes other than to ask, “Is it a good outcome?” That is the important thing, and to suggest that private provision of the outcome and of the service provided is fundamentally bad is simply wrong. Such provision was introduced and brought in by the previous Government, and it assisted the public provision. The two can work together, and that is a good thing. I shall support the Bill, and I make this point to finish: the NHS is clearly a wonderful institution that all in the House cherish and support, and this is a Bill that supports it.

Valerie Vaz: It is always a pleasure to follow the hon. Member for Hexham (Guy Opperman), and it is good to see him sitting in his place. I welcome him back to the House and commend him on his great recovery. He is actually looking better than before, if I may say so.
	Let me take up one point that the hon. Gentleman made. As a barrister, he will want people to go to litigation, but as a solicitor I mostly counsel people not to. It is the most terrible, prolonged and costly event—but I appreciate that he wants litigation, because that is his bread and butter.
	As for the legal advice, I asked on a number of occasions for the legal advice that the Department had and it was refused on all those occasions. The hon. Gentleman can talk about 38 Degrees, but thankfully that organisation is interested in the public and knows
	that they need the legal advice that was not provided, even though it was paid for with taxpayers’ money. I challenge the Secretary of State to lay it in the House of Commons Library, if the other advice is so hurtful to him. What is the problem? His Bill is being discussed and there is nothing to hide. I say that he should place his legal advice in the Library.
	I am a Member of the Select Committee on Health and Sir David Nicholson, the new chief executive of the NHS commissioning board, appeared before us when I was first elected. He was then on the verge of retirement—

Andrew Lansley: No, he wasn’t.

Valerie Vaz: He was: he had a very big smile on his face and he said, “I’m about to retire.” [ Interruption. ] With the greatest respect, the Secretary of State was not there. Sir David was asked to stay on to preside over the NHS commissioning board, which he has described as
	“the greatest quango in the sky.”
	I think that the NHS commissioning board is going to be the new Secretary of State for Health, with all the powers but none of the accountability. The NHS has been quangoed—not coloured orange, as in the advert, although that might happen when the Bill goes to the other place, but coloured the blue of betrayal. These are not reforms: they are a complete dismantling and looting of our precious resource. This is not selling off the family silver, but selling off the whole estate, the freehold and the family crest.
	It is not just Opposition Members who are concerned about accountability. There are widespread concerns about the accountability of the NHS commissioning board and commissioning consortia regarding public money.

Andrew Percy: Will the hon. Lady give way?

Valerie Vaz: No, I will not.
	I again ask the Secretary of State for Health what discussions he has had with the Cabinet Secretary about the change regarding accountability for the public money that will be transferred—£60 billion of it—to those quangos. If he is asked questions about this in the House he will say that it is an operational matter.
	I want to show hon. Members what the scenario will be like, because this is already happening in my constituency and this is what it will be like throughout England. The out-of-hours GP and urgent care service provider Waldoc has just lost the contract to provide out-of-hours services after 16 years, without a right of appeal to the strategic health authority and despite a patient satisfaction rate of 95%. When the contract was lost and staff turned up to find out whether they had jobs, they did not even know whether they would have a job the next day. That is how they have been treated. This has been happening in most PCTs, as some Members will know from their constituencies. People have left, vital expertise has gone and no one from the Government side has been able to give us a figure for the redundancy costs. When I asked the Minister how much this whole reorganisation would cost, he said he did not know the figure and that there was no new money. That must mean that money has come out of services.
	We have, however, had a figure—£1.4 billion—from Professor Kieran Walshe of Manchester university. No wonder waiting times have gone up. Members of the public need to know that in an increasing number of areas, consortia will be conducting competitive tenders in which, potentially, foundation trusts, the constituent members of consortia and commercial providers will be bidding. Clearly, there will also be a conflict of interest. It has been estimated that a single procurement process can cost from £5,000 to £30,000. That is a waste of public money, and the whole regime of procurement is a waste of costs.

Paul Burstow: rose —

Valerie Vaz: What is so extraordinary is that the Secretary of State does not want to be the Secretary of State; he wants to let the Future Forum consult and listen to people, but that is not how decisions are made in government. In government people hear the evidence from all sides—[ Interruption. ] I have made it pretty clear: the Minister has had his time, but I am a Back Bencher and I do not get much time to speak.
	People in government hear the evidence from all sides and weigh things up. Then they make a decision reasonably and give their reasons. The Secretary of State is hiding not only behind the Future Forum but behind the NHS commissioning board. He is like Macavity the mystery cat:
	“At whatever time the deed took place—MACAVITY WASN’T THERE!”
	I would like to draw hon. Members’ attention to a paper dated 29 August 2011 by Dr Lucy Reynolds, Dr John Lister, Dr Alex Scott-Samuel and Professor Martin McKee, “Liberating the NHS: source and destination of the Lansley reform”, which I will place in the Library. It draws a link between a paper written in 1988 by the right hon. Member for Wokingham (Mr Redwood) and the Minister of State, Cabinet Office, the right hon. Member for West Dorset (Mr Letwin). It is therefore no surprise that when the Minister of State, Cabinet Office was called in to look at the proposals he endorsed them, because they were his. Paragraph 3 of the paper is entitled, “Implementation of the Redwood/Letwin Plan in the Lansley reform”. The paper was sent to me by a young academic who said that his life had been saved twice by the NHS but would not have been saved under an American-style privatised health system.
	The most recent satisfaction survey by Ipsos MORI last March showed 72% public satisfaction with the NHS, but it was not published by the Department of Health even though the Department had asked for it to be done. Members will have seen a report from Colin Pritchard and Mark Wallace which said:
	“In cost-effective terms, i.e. economic input versus clinical output”,
	the UK health service was “the most cost-effective” in reducing mortality rates, compared with the US health care system.
	Finally, I say to hon. Members—including the hon. Member for Hexham—as they think about what has been said, “Stand up for democracy, stand up for the trust between elected representatives and their constituents, and stand up for the NHS: vote against this Bill.”

David Tredinnick: I am most grateful for being called to speak and for the opportunity to follow my colleague on the Health Committee, the hon. Member for Walsall South (Valerie Vaz), and my hon. Friend the Member for Hexham (Guy Opperman), and to say how pleased I am to see my hon. Friend in his place. I know from experience—not personal experience—just how tough that operation can be, so many congratulations to him on his recovery.
	I want to make a short speech on just one issue—patient choice, which is one of the most important, if not the most important, aspects of the Bill—and to challenge my right hon. Friend the Secretary of State on one or two points. Chapter A1 13H sets out the duty that the board has, in the exercise of its functions, to
	“promote the involvement of patients, and their carers and representatives…in decisions about the provision of health services to…patients.”
	That patient choice depends on clinical commissioning, the subject of the amendments before us, and that in itself hangs on the “any qualified provider” policy, modified recently from “any willing provider”. There I have some concerns.
	The TUC brief summed up “any qualified provider” very well:
	“Under AQP, patients will be able to choose which provider to use for their treatment, from a list of approved providers (private, public or voluntary sector) who perform the service in exchange for a locally or nationally set tariff.”
	Where I have a slight problem is that although the categories of treatment that can be employed, certainly in the transitional year 2012-13, have been set out in the operational guidance, I think there is a strong case for the guidance to be in the Bill itself.
	However, I am very pleased to see at the top of the list musculoskeletal services for back and neck pain, and I presume, although it is not set out, that that means greater use of osteopathy and chiropractic, both regulated by Acts of Parliament, in 1993 and 1994. I had the honour to serve on the Committees considering those Bills. As the public are to have greater choice, we must look at providing that choice, and they will be asking for those services. They will also want acupuncture for musculoskeletal problems. Acupuncture has been approved by NICE and there are now NICE guidelines supporting acupuncture for use in these services. I would like my right hon. Friend the Secretary of State to consider at some point making a more positive, more specific commitment to the use of those services in the provision for patient choice.
	There is a strong case for the “any qualified provider” policy to be set out in the Bill too, although it is set out in the operational guidance. The problem that may occur is in the qualification process. I have no problem with its asking for safe, good-quality care or with the governing principle of qualification being that practitioners be registered with the Care Quality Commission and Monitor, but what about those therapies that do not have those badges in their passport? What about traditional Chinese medicine, which is about to be regulated by the Health Professions Council? May we have a specific assurance that its practitioners can be part of this patient system? Traditional Chinese medicine and
	acupuncture have increased in popularity dramatically—Chinese practitioners may now be found in any town in the country.
	I suggest to my right hon. Friend the Secretary of State that other therapies should be included in the list. He has produced a second list of services to be introduced in 2013-14, which includes community chemotherapy and home chemotherapy. If we are to offer patients choice on those chemotherapy services, we really ought to consider those who can support people who are exhausted after chemotherapy and radiotherapy. I am thinking of not only those who practise traditional Chinese herbal medicine and acupuncture, but the healing fraternity and those who use therapeutic touch, many of whom now work in NHS hospitals to great effect.
	I should also like to refer to homeopathic medicine, which I have discussed when you have been in the Chair before, Madam Deputy Speaker. I think I am right in saying that your constituency is not far from the Bristol homeopathic hospital, so perhaps you will not call me to order on this, especially as I am trying to stay in order. Many people use homeopathy every day to cure simple ailments, because it is cheap, easy to understand and very effective. Even if there are not umpteen double-blind placebo-controlled trials, there is a wealth of evidence that it works. I would draw my right hon. Friend’s attention to the fact that the Royal London hospital for integrated medicine, which used to be called the Royal London homeopathic hospital, has the highest patient satisfaction rating of all hospitals in the United Kingdom.
	There is a case for including in the Bill clearer direction about the services that will become available. I ask my right hon. Friend to smile on those other disciplines that do not have statutory regulation but perhaps have robust non-statutory, voluntary regulation, such as acupuncture, and ensure that when patients go to their doctors and say, “Doctor, this is what we’ve used; this is what we really want,” they will not be turned away.

Joan Walley: Following the hon. Member for Bosworth (David Tredinnick) illustrates the problems that we have with the Bill: even at this stage, specific details need to be discussed and have a case made for them, so that the future of NHS provision can be fully taken on board. At the same time, because of how the Bill has been handled—we have had a re-committal—we have a political debate.
	The debate on this specific group of amendments is taking place on two levels. I certainly want to ensure that the true principles of the NHS and its founding fathers, such as Nye Bevan, are followed in future provision. We need that political debate to ensure that the NHS is politically accountable. We have almost lost that opportunity, because we are in this mess, with all this uncertainty and not knowing how the Bill will shape up and go forward. We risk losing the whole of the NHS altogether.
	Many people who are part of the medical profession and others who are concerned about their own future health care have contacted me, because they want the Government to be in control and the Secretary of State to have a duty to procure and provide services. This is a political debate, as much as anything else, but it is difficult to have that political debate within the confines of the amendments, although they are central to that debate.

Lyn Brown: One of my biggest worries about the Bill is that it will stop me intervening in the health service to encourage outcomes for my constituents who come to me for help and advice. Does my hon. Friend agree that it will diminish my ability to represent them, rather than enable me to do so?

Joan Walley: My hon. Friend is right. Constituents go to Members of Parliament as a last resort to try to ensure fairness in how the system deals with everything. I have just had a high-profile case in my constituency relating to the postcode lottery, which my hon. Friend the Member for Pontypridd (Owen Smith) referred to.

Paul Burstow: The hon. Lady is making some important points and is trying to respond to that raised by the hon. Member for West Ham (Lyn Brown). Interestingly, the hon. Member for Leicester West (Liz Kendall) earlier recounted all her concerns about the PCT and how it has dealt with GP services in her area. The anxiety seemed to be that the PCTs were not accountable, but the hon. Member for Stoke-on-Trent North (Joan Walley) now seems to be saying that they are.

Joan Walley: We have just had an awfully long debate about precisely that issue. Many of us would say that the PCTs were not operating accountably, but Members of Parliament could have influence and bring pressure to bear. The last resort is through the Secretary of State, and it is important that that should be retained in the Bill.

Owen Smith: Does my hon. Friend agree that the critical points are that there is an unknown into which we are stepping with the Bill and that the presumption is that the culture will be different? There will be a presumption of autonomy, being hands off, less accountability and more localised decision making. It is therefore perfectly reasonable to presume that we will have less input.

Joan Walley: That is right and it comes back to the fact that, somehow or other, under the new regime, whatever it ends up being, there will not be the fairness or the universal provision. In certain areas—perhaps those such as mine, which have much greater deprivation and much greater health inequalities than others—things will be more difficult.

Andrew Percy: I do not recognise the picture that the hon. Lady is painting. The real issue with the provision and availability of services is more to do with the funding model that is in place. When my local PCT was unable to provide dental services and when the bed numbers at Goole hospital were reduced a couple of years ago, local people had no ability to influence those decisions, no matter how much they appealed to the Secretary of State, because it comes down to money.

Joan Walley: Of course it comes down to money, but it also comes down to fairness in how the money is allocated. That must relate to an overall sense of direction to deal with health inequalities.
	I want to discuss very specifically three amendments that I have tabled, but I did not want to go into the detail without associating myself with some of the concerns that exist across the country which have not yet been resolved. I speak as an honorary vice-president
	of the Chartered Institute of Environmental Health. I tabled the amendments to ensure that we do not just pay lip service to environmental and public health, and that we truly get a Bill that is fit for purpose in respect of the prevention agenda and the new arrangements under which we will be operating, which should give more status and priority to environmental health.
	I want to speak in favour of the Government looking either now or in the other place at the case for a chief environmental health officer for England. The reason for that is the fact that, historically, there was a post of chief environmental health officer, going back to the days before 1974 when local authorities last had lead responsibilities for public health services and when each authority had a medical officer for health.
	Today, England has a chief medical officer, but not a chief environmental health officer. I heard what the Minister said about that, but I urge him to have further talks, if necessary, with the professionals to see how we could ensure that a chief environmental health officer for England was appointed. Earlier we talked about Wales, where there is a chief environmental health officer post. In all the arrangements in Wales and in Northern Ireland, there is a recognition of the role played by environmental health in promoting health and well-being, and of the importance, therefore, of ensuring there is an environmental health input to policy making at the highest level and at the strategic level. I believe that is what England currently lacks. If the Bill is to give a higher profile to public health services, and the lead in public health is to be provided by local authorities, which is where the environmental health work force is located, it is necessary to make corresponding arrangements such as my new clause could facilitate, if the Government gave it serious consideration.
	It is envisaged that if we had a chief environmental health officer, he or she could focus on a preventive approach to achieving good health outcomes, and in particular the wider determinants of good health and well-being. I see that post holder reviewing relevant data, advising the Department of Health, Public Health England, NICE and the chief medical officer on preventive strategies and the wider determinants of health, as well as overseeing the development of good practice within local authorities and their partner organisations. In response to points made earlier, let me add that an annual report to Parliament by the Secretary of State on the work of the chief environmental health officer could ensure the accountability of that official.
	Amendments 1242 and 1243 would place a duty on public health authorities to work in co-operation with their public health partners. Without that duty, the co-ordination that was mentioned earlier will not be achieved. There will be no mechanism for all the different strands of policy and health care provision to come together. As all Members know, not all local authorities in England are to be public health authorities. For example, in areas of England with two-tier local government, the powers and duties apply to county councils but not to district councils. For example, in my constituency Staffordshire county council, rather than Newcastle borough council, will have the responsibility but not the environmental health officers to perform the role.
	A duty to co-operate could make a significant difference. The public health work force directly controlled by local authorities will be carrying out the work. I urge the Secretary of State to consider that. There is a precedent in respect of children’s safeguarding and in respect of the emergency services. Although I object to many aspects of the Bill and will not support it, if it goes through it should at least contain the safeguard for public health that a duty to co-operate would provide.

Andrew George: It is a great pleasure to follow the hon. Member for Stoke-on-Trent North (Joan Walley), who addressed the issue of political accountability in a considered way. I shall return to that and relate it to a number of amendments in my name and those of some of my hon. Friends. I shall refer to a number of amendments that the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) covered in his opening remarks and dealt with in a fair and balanced manner, although not entirely to my satisfaction in every case. I shall also raise further questions.
	I have enormous respect for all that my hon. Friend has done. His contribution to the debate on social care is second to none. That expertise is especially beneficial to the Government at present and some important advances have been made, for which we are all grateful. I acknowledge that he approaches all aspects of his work with the best of intentions, and I do not question those. The amendments that I have tabled indicate that I believe we may need to reconsider some of these issues. I should also mention at this stage that I may seek to push one or two of them to a vote.
	On Second Reading, I made a speech that was critical of the Bill and refused to support the Government by abstaining at that stage, and of course the Bill has gone through a number of significant changes since then and concessions have been made. I have been criticised by some for making that speech and refusing to support the Government, but I feel vindicated as a result of the pause and the listening exercise. I might be criticised and accused of disloyalty, but that is how Back Benchers exercise our role of holding the Government to account. It is reasonable for us to use our powers to bring forward amendments and, in so doing, probe the Government and ask them to be accountable for the policies that they are bringing forward. I hope that in the weeks and months ahead, I will be vindicated for having done so, but I do not necessarily expect that acknowledgment to be provided now.
	I was relatively content with the original coalition agreement. I am no great defender of primary care trusts, but I think that using the existing institutional infrastructure, grafting in accountability to the patients and communities that the commissioning bodies will serve and ensuring clinician involvement in those commissioning decisions, would strike entirely the right balance. That would provide a way of going forward without scuppering, dismantling or exploding the whole system in the way the Bill is doing.
	There was no mention in the coalition agreement of changing the duties of the Secretary of State, and I have read a number of legal opinions on that issue. I also believe, as I have indicated in several interventions so far, that some of us have been misled on that point. Some of the legal advice that I have been given by colleagues suggests that the Secretary of State in fact
	never had a duty to provide in the 1946 Act. That is fundamentally wrong. Perhaps I will discuss this with the Minister after the debate and show him the documents that I have been given and some of the comments that have been made. As some of my colleagues who were there at the time and heard the advice will know—
	[
	Interruption.
	]
	I hasten to add that they were not there in 1946—I know that I have aged in my time in Parliament, but I cannot recollect that time. My colleagues know that we have been briefed that there was never any duty to provide in the 1946 Act, but there is evidence—I do not need to give the quote a third time—that there was clearly a requirement in the 1946 Act to provide and secure effective provision. That requirement has always been there in successive health Acts in this country. I want to relate that to a point the hon. Member for Pontypridd (Owen Smith) made in a more tribal manner.

Paul Burstow: May I just make it clear that I do not think that I or any other Minister at any point, either at the Dispatch Box or in other discussions, ever suggested that the 1946 Act or any subsequent Act did not have the duty to provide? What we have said is that the duty to provide has progressively, particularly over the past 20 to 30 years, become a duty that is not exercised. It has been delegated and is increasingly exercised instead by separate bodies, such as NHS trusts and foundation trusts, using their own independent power to provide services.

Andrew George: Yes, and my new clause 16 proposes to address that issue through an opportunity for the Secretary of State to intervene as necessary.
	The Secretary of State in his intervention on the hon. Member for Pontypridd made it clear that in any case Secretaries of State tend not to micro-manage by intervening or by providing on every whip and flip, and there is no suggestion of that, but as a backstop we require the guarantee that, if all else fails and the whole system does not provide what we believe needs to be put in place to provide for a comprehensive health service, the Secretary of State will be there. There would be no harm in putting that word back in the Bill in one form or another. I do not understand the obstinacy, and in my view there is no legal impediment to the Government doing so.

Stephen Lloyd: Does my hon. Friend agree that, because this is such a totemic issue, the key reason behind the proposed change in the wording is totally to reassure the public that, come what may, and even if delegated powers mean that the Secretary of State has not been involved for a number of years, the buck will stop with the Secretary of State?

Andrew George: I am grateful to my hon. Friend. He has referred to the issue as being totemic, and although I do not want to detain the House for too long because many others have referred to it, he is absolutely right. Now that it has been raised in such a manner, unless there are good legal reasons not to insert it in the Bill, it should be.
	On the comments of the hon. Member for Pontypridd, I make a further point. We are talking about major changes, and the issue is not only totemic but contextual, because, in the context of a major—in fact, the most
	major—reorganisation of the health service, the reassurance of that backstop being in place would be all the more important.
	I do not questions the intentions of the Secretary of State, for whom I have tremendous respect, but, having opposed the creation of the health service in the first place, the Conservatives have a problem, because the context is one of a major change, and whether we like it or not the assumption is that, if the Secretary of State is a Conservative, the hurdle will have to be set higher to reassure the nation that there is no untoward intention behind the legislation.

Simon Hughes: My hon. Friend knows that I share his views, and the hon. Member for Stoke-on-Trent North (Joan Walley) made the point that this is both a political and a legal debate. First, there is certainly a political argument for keeping the definition the same as it has been throughout the history of the NHS, which was created in concert by a Liberal and implemented by Labour. Secondly, there is a legal justification for doing so, because there are specific powers to provide, and therefore there is a generic logic in stating that, as part of the initial definition, there is provision for and security of health services. I am therefore sure that my hon. Friend will be on a winning wicket in the end.

Andrew George: I hope so, but sporting my cricketing injury I hope that that analogy does not apply.

Nick Smith: I congratulate the hon. Gentleman on this point and think that he should absolutely stick to his guns. In my constituency, the birthplace of the national health service, 40 people have written to me about the issue in just the past few days, so it is important that he sticks to his guns and we get the message over to the Secretary of State this evening.

Andrew George: I am grateful to the hon. Gentleman, but I should also say that the Minister acknowledged in his opening remarks that there was an issue that needed further work and clarification. I entirely welcomed that statement and will be happy to be involved in any discussions that might advance the point. However, in spite of the discussions and debates so far, the issue remains unresolved. It might be resolved in another place, but until then it is important to make the totemic point that the matter is of such significant concern that it is worth our while pressing the matter further.
	I shall canter through my many amendments as briefly as possible. We are under a time constraint, and I will try to move through them as quickly as I can. I hope that hon. Members will bear with me if I do not take further interventions.
	New clauses 16 and 17 would remove the independence of the commissioning groups from the NHS board by restoring the Secretary of State’s power to delegate functions to NHS commissioners and direct them where appropriate. That allows the restoration of the Secretary of State’s duty to provide or secure provision of the health service as per the 1946 Act, which used those very words. That would restore fully accountable spending in respect of the £80 billion of taxpayers’ money that
	goes through that route. We cannot provide a duty without providing the power, so the two things are clearly linked.
	Amendment 1197 would delete clause 4; it involves the “hands off” issue that has been raised before. Clause 4 would otherwise prevent the Secretary of State from directing clinical commissioning groups and the NHS commissioning board. Amendment 1198 would delete the same duty in respect of the NHS commissioning board, but would not interfere with clinical commissioning group autonomy.
	Rather than just asserting the opposite, will the Minister publish the legal advice that appears to contradict the advice that has been obtained? That states that the “hands off” clause is a real barrier to the Secretary of State’s intervention—as, after all, it is designed to be. Members could read the two bits of advice and see which was more convincing. Better still, will the Minister amend the Bill to put the matter beyond doubt?

Paul Burstow: I draw my hon. Friend’s attention to the Department of Health’s website. Yesterday we published a detailed response to both 38 Degrees opinions. It obviously draws on the legal advice given to Ministers and provides a full exposition of why we believe the points that I set out in my opening remarks.

Andrew George: I am grateful to my hon. Friend for that. During his remarks, he said that he believed that there was a risk that the Secretary of State might be drawn into micro-managing; that was one of his primary arguments. All I can say is that if there were a risk of the Secretary of State micro-managing, the Secretary of State could decide to do or not to do it. Simply removing the power comes back to my point about at least making sure that the Secretary of State has the ability to direct where appropriate. If the Secretary of State had that duty to provide, it would follow that he must have the powers to intervene as I have described.

Paul Burstow: My hon. Friend is making some important points, which give me the chance to underscore the important points that I have made. The Bill retains for the Secretary of State the capacity to intervene and exercise the functions of all the bodies established by it, and—in extremis, as a last resort—to make sure that services are provided. It is clear that that capacity has remained, not least in regard to the Secretary of State’s ability to establish special health authorities.
	My hon. Friend is asking for back-stops, and back-stops have to be real and have effect. That is why we put them into the Bill as we have, so that the Secretary of State does have, in extremis—in the circumstances that concern my hon. Friend and others—the ability to take the steps necessary to secure and ensure that services are provided to ensure a comprehensive health service.

Dawn Primarolo: Order. May I gently remind the Minister of two things? First, he has to address whole House. Secondly, it is not a private conversation between him and his hon. Friend, and his interventions are supposed to be brief. A lot of people are waiting to speak.

Andrew George: On that basis, Madam Deputy Speaker, I will end that part of the conversation and move on, acknowledging that my hon. Friend has made a point that is worth considering.
	Amendment 1224 would restore the duty to provide or secure provision of health services. Although that is seen as the headline proposal, it is consequential on new clauses 16 and 17, hence my intention to draw attention to the likelihood of my seeking to divide the House on those issues.
	Amendments 1222 and 1223 seek to establish why the Bill has never provided for the Secretary of State to provide or secure a comprehensive health service rather than promote a comprehensive health service. This is an either/or situation, but I draw attention to the possibility that instead of pressing new clause 16, I may, in discussion with others, seek to divide the House on amendment 1222.
	Amendment 1183 would beef up a duty of the Secretary of State—a theme that runs through a number of amendments. The purpose of amendments 1183 and 1194 is to address the conflict between having regard to reducing inequalities and placing above that duty the other duties that apply—for example, on choice. Amendment 1183 seeks to ensure that it is the duty of the Secretary of State, in reducing inequalities, to
	“act with a view to”
	rather than merely “have regard to”. Otherwise, the responsibility, and the duty, on the Secretary of State is rather weak. That applies to amendment 1194 in the same manner.
	New clause 18 would impose a new duty on the CQC, the NHS Commissioning Board and clinical commissioning groups not to undermine existing NHS services in an unplanned way through the operation of competition. Rather than extending my description of this issue, it might be worth referring to the debate that we had yesterday about the regulations surrounding the functions and duties of Monitor, as the same question arises. We have to look at the impact that competition is likely to have on the provision of essential services such as major trauma and accident and emergency, where its existence may destabilise emergency services through the loss of, for example, important underpinning elective services provided by the hospital.
	New clause 20 would ban the wholesale outsourcing of commissioning work with regard to clinical commissioning groups. That was demanded in a Liberal Democrat conference motion but has still not been delivered. The commissioning process is a public function, not a private function. The amendment therefore seeks to change schedule 2 in different ways to prevent private entities on clinical commissioning group committees and sub-committees from commissioning and making other decisions. This also applies to amendments 1224, 1245, 1244 and 1249.
	The Minister said that the work of the Neurological Alliance is important to preserve. I hope he will recognise that new clause 20 talks only about commissioning work being
	“predominantly retained as a function by staff directly employed by the clinical commissioning group.”
	There is nothing in the Bill that prevents the bulk of the commissioning work—not the decision, but the work—of a clinical commissioning group from being done by a private company and thus, potentially, in secret. I hope he will accept that under the current wording of schedule 2,
	private entities will be able to sit on clinical commissioning committees and sub-committees and make commissioning decisions.
	Amendments 1184 to 1188 and 1195 would demote choice to being a subsidiary duty of commissioners to tackling fair access and tackling inequality of outcomes. They relate to page 17 of the Bill. The priority of choice over inequity and inequality was introduced by the Government after the pause and the NHS Future Forum report as a way of promoting competition in ways other than through the role of Monitor. The amendments would reverse that priority for the NHS commissioning board.
	Amendment 1211 provides that clinical commissioning groups should be more coterminous with local authorities than is the case under the Bill. The Minister said that there is no intention that clinical commissioning group boundaries will cross local authority boundaries. However, we all know that district councils do not cross local authority boundaries. In Cornwall, for example, we are likely to move from one PCT to three clinical commissioning groups, which will make the streamlining of the pathways between health and social care a lot more difficult. The purpose of amendment 1211 is to enforce that point.
	I am aware of time and I hope that the House will appreciate that I will not explain every aspect of the many other amendments I have tabled. I am aware that there are significant issues that other people wish to raise. I simply emphasise that what the Minister said about health and wellbeing boards being able to refer matters to the Secretary of State is once again something that we have always argued for. Local authorities should of course be given a far greater say in commissioning decisions and in setting the strategy for health services in their area. As a back-stop, it is important that matters can be referred to the Secretary of State. My hon. Friend the Member for Cheltenham (Martin Horwood) has tabled some important amendments in respect of public health, some of which I have supported, and I hope that the Minister will consider them. I apologise for the amount of time I have taken, but I hope that the Minister will address the important issues advanced by the amendments.

Caroline Lucas: I apologise for not being present for the first half hour of this debate. I was in the Environmental Audit Committee, where I had specifically asked for certain witnesses to be invited, and I have not yet worked out how to be in two places at once, although it is on my list.
	I will make a few general points about this part of the Bill before turning to a couple of the amendments that are in my name. I echo the many concerns that have been expressed around the Chamber this afternoon. Many of us argue that there is no legal duty on the Government to provide health services. The new hands-off clause limits the Government’s ability to intervene should health care provision be deemed inadequate, because it says that clinical commissioning groups, the new agents of health provision that can include private companies, must be free to exercise powers and duties without “unnecessary burdens”. I am equally concerned that the powers and duties of a commissioning group, including its ability to award contracts and charge for commercial activities, could be exercised by a private health care company. The Bill opens the way for private companies
	to determine much of English health care and takes away the Government’s duties and powers, which is why I believe it should be opposed.
	I should like to say a few words about a couple of amendments in my name, starting with amendment 48. It offers Members the chance to return the NHS to its core ideals by making all health services in the UK, including dental care, eye care and prescriptions, free at the point of delivery based on each individual’s needs and not their ability to pay.
	I am sure some Members will say that the argument was lost some 60 years ago, but I argue that, unfortunately, the facts show that returning the NHS to being a fully free service is as important as ever. In 2008, an Ipsos MORI poll for Citizens Advice revealed that about 800,000 people in England had failed to collect a prescription because of the cost involved. An Asthma UK survey found that 34% of people who had to pay for their asthma medication sometimes chose not to take some of their treatment because of the expense. Research published by Rethink in 2008 showed that 38% of people with severe mental illnesses such as schizophrenia had to choose between paying household bills and paying prescription charges.
	Despite 85% of us admitting that we have problems with our vision, 37% are put off having a sight test because of worries about money. That shocking statistic shows the extent to which fear of cost is as much of a barrier as actual cost, as more than 30 million people in the UK are entitled to free eye care paid for by the NHS and many more are entitled to free eye care paid for by their employer. The result of that confusion is that more than 20 million people are putting their sight at risk by failing to have regular sight tests.

Andrew Percy: The hon. Lady is making an interesting argument, and I would just ask her two things. First, how is she suggesting that we should pay for the idea? Secondly, is she seriously suggesting that we should return to millionaires being provided with dental treatment and eye care free of charge?

Caroline Lucas: It seems to me that if Wales and Northern Ireland have been able to abolish prescription charging altogether, it is certainly possible to do it. I would also argue that although everyone collectively having a stake in our public services may well mean that millionaires get a free eye test, under the type of regime that I would like to see they would be paying an awful lot more tax than they are under the Conservative party’s regime.

Fiona O'Donnell: I am aware that the hon. Lady sits close to Scottish National party Members, who may not have given an accurate picture of what has happened in Scotland. We have free prescriptions, but we also have 1,200 fewer nurses. People such as me are getting our prescriptions free, but that puts strain on other parts of the service.

Caroline Lucas: I thank the hon. Lady, but I do not agree that the two points that she makes are causally linked. Of course I do not want to see the abolition of nurses, but that does not mean that we should have to pay for our prescription charges. Either we want an NHS free at the point of delivery and with free eye
	tests and so forth or we do not.
	[Interruption.] 
	Someone is speaking from a sedentary position, no doubt asking how we will pay for it. I will be very clear that there is massive potential in cracking down on tax evasion and avoidance, higher tax for the rich, higher corporate tax and so forth. We are essentially talking about political priorities. The priority that I represent—a great many more people are coming to this view—is that we should be willing to pay for the public services that we want.
	Hon. Members may oppose amendment 48 on the basis that charging for prescription or for dental and eye care is an important way of raising revenue. In England, eligible patients pay a prescription charge of £7.20 an item. In Scotland the charge is £3 and Wales and Northern Ireland have abolished prescription charging altogether. England raised just £470 million through the charges in 2009-10, which was just 0.5% of the NHS resource budget.
	Crucially, we should remember that income from charging in the NHS is not pure profit. There is a real cost to administering the plethora of exemptions and reduced charging rates for which different groups are eligible. For example, there are 11 different groups that are eligible for free dental care, 15 that are eligible for free sight tests and 12 that are eligible for free prescriptions. I hope that hon. Members will see the benefit of doing away with that convoluted and complex system, which provides little benefit in terms of income, and which goes directly against the NHS principles by significantly reducing people’s access to all forms to health care simply because of their inability to pay.
	Much has been said by hon. Members on both sides of the House about the founding principles of the NHS, and it will continue to be said. However, I put it to hon. Members that amendment 48, more than any other, seeks to point out that much important NHS care and treatment is charged for, and that we need to go back to NHS services as they were envisaged by its architect, who has been referred to many times this afternoon. Hon. Members might recall that he resigned as Health Secretary as early as 1951, in protest at his Chancellor’s efforts to impose charges for prescriptions, dental treatment and eye care.
	Amendment 1181 raises serious concerns about the way in which CCGs will be able to charge for services. Although the power to charge, under proposed new section 14Z3 to the National Health Service Act 2006, is intended to be of benefit to the health service, it is very disturbing. Its scope is unclear—I wrote to the Minister last week to ask for clarification—but the fact is that important limitations on how the Secretary of State can exercise that power would apparently not apply to CCGs. The measure could run a coach and horses through the principle of a free health service, and Parliament needs to be clear on its impact in practice.
	It is extremely worrying that CCGs will be able to decide that certain specialist services—for example, for pregnant women or women who are breast feeding young children, or aftercare—are not appropriate as part of the health service. That would mean that the statutory guarantee that the NHS will be free will not apply, because CCGs can decide that certain services and facilities should not be provided as part of the NHS. If that happened, CCGs could use the charging
	power to decide to charge for supplying, for example, goods to pregnant women, or for instructing people how to use their rehabilitation equipment.
	Amendment 1181 would ensure that that could not happen. Ministers might say, “CCGs are commissioners and not providers”. If so, why is a measure that allows CCGs to charge necessary in the first place? The amendment would make it absolutely clear that there is no way in which a CCG could charge for anything that is related to the basic core health service, such as hospitals, doctors, nurses or ambulances, whether they are acting under section 3 or proposed new section 3A of the 2006 Act. The amendment would also impose on CCGs the same limitation that is already imposed on the Secretary of State. Why was that omitted from the Bill?
	It is right that raising funds under that power should not interfere with a CCG’s functions. However, the Bill says that raising funds should not interfere significantly, but what on earth does “significantly” mean in that context? How is it to be determined or measured? If companies such as UnitedHealth got hold of that power and reckoned they could make money out of it, they will be on to it in a flash. The very least that they should be required to do is demonstrate that dealing in land and supplying goods and the like will not take them away from fulfilling their commissioning role. I would prefer it if those giant profit-driven companies were nowhere near the health service, but while they are, we need far greater safeguards than currently exist.
	Unfortunately, the previous Government gave overseas companies the legal route into the NHS, and this Government are seeking to smooth that route yet further. Hon. Members may recall that at Prime Minister’s questions on 18 May, the Prime Minister claimed that he had not heard of Mark Britnell, one of his health advisers, who was also a key adviser under Tony Blair, until he googled him the previous Sunday. The Prime Minister’s interest was stoked by a report of a speech that Britnell, global head of health care at KPMG, gave to a group of private health companies in New York last October. Dr Philip Hammond pointed out in Private Eye that according to a brochure summarising the conference, Britnell said:
	“GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process…In future, the NHS will be a state insurance provider, not a state deliverer…The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”
	That is a shocking thing to say, and no wonder the Prime Minister was keen to distance himself from it, at least in public.
	My last point is about the final proposal in amendment 1181, which would mean that:
	“Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.”
	Without the amendment, it is completely unclear what CCGs will do with the money that they raise and how, if at all, it will affect their budget allocations. I think it would be madness for Parliament to give CCGs the right to charge for supplying goods, dealing in land and providing instruction for the purposes of raising more
	funds for the NHS, and then not to require them to account for it in any way, and not to ensure that the funds find their way back to the public rather than the private purse. This part of my amendment seeks to ensure that that is done.
	Amendment 1234 refers to the fact that once they managed to get into the CCGs, multinational health companies such as UnitedHealth would be allowed to do the actual commissioning, thus creating a very unhealthy form of what is effectively in-house outsourcing. I understand that they will be able to charge for the supply of goods if the Government do not accept the amendment. Parliament cannot trust companies whose primary duty is to their shareholders to be in charge of so much taxpayers’ money, nor should such companies be given the right that the Secretary of State currently holds to charge for the supply of goods or for land deals. We should make clear that CCGs cannot agree among themselves that their functions will be carried out by one of their private company members. Commissioning is a public function that should be exercised in the public interest, and private companies such as UnitedHealth should not be entitled to charge for any it.

Nick de Bois: I refer Members to my entry in the Register of Members’ Financial Interests. I wish to speak to amendments 1172 and 1173, in my name, which require the Secretary of State to collect haematopoietic stem cells. The issue is, of course, that of the collection of umbilical cord blood and cord bank policy, which was first raised in the last Parliament.
	I pay particular tribute to the work of the all-party parliamentary group on stem cell transplantation for its work under the leadership of the hon. Member for Alyn and Deeside (Mark Tami), and to the enormous contribution and determination of my hon. Friend the Member for Enfield, Southgate (Mr Burrowes). My previous lack of knowledge of the subject was probably no different from that of many other people, but after giving my hon. Friend and neighbour a lift home on several occasions I became a speedy convert. Quite simply, the collection of cord blood can be life-saving. I pay tribute to the work of the Anthony Nolan trust in that regard.
	In 1974 the Secretary of State was not obliged to facilitate stem cell transplantation from unrelated donors. Because the Governments of the day took that position, advances made took longer to achieve, which undoubtedly cost lives. The situation is different now: both the Government and the Opposition support expansion of the practice, and in particular of the more modern use of umbilical cord blood for such purposes. However, it would be fitting for the Minister now to make it clear in the Bill that this issue is important, to lock in the bipartisan support while it is strong, and to send a message to future Governments and civil servants that for as long as the Bill remains on the statute book, the issue is not to be lightly disregarded or de-prioritised at a future date.
	The amendments involve no financial or political cost, but they are not merely symbolic. They could be described as an insurance policy against the risk of thoughtlessness or distraction on the part of future Governments—a risk that would ultimately cost lives.

David Burrowes: It will not surprise the House to learn that I strongly support what my hon. Friend has said about the importance that should be attached to the life-saving cause of collecting cord blood and transplantation. As he has said, the Government are wholly committed to investing in and improving collections and to transplantation, but is it not important for us to consider whether that should form part of the duty of the Secretary of State? Is it not a priority, given that one in five members of black and ethnic minorities cannot obtain a match for the purposes of the transplantations that are sorely needed for life-saving operations?

Nick de Bois: My hon. Friend raises a key point. If we were to make prospective parents aware of the possibility of donation, we could address the major deficit in the BME community.
	I will not take up too much of the House’s time, but I hope Members will bear with me as I reiterate some of the important points that drove me to table these amendments. Patients in the UK requiring a bone marrow donor have a one in four chance of survival. Only 50% of those looking for a donor will find one, and of those who do so only 50% will survive. Many of those who find a bone marrow donor do so too late for the treatment to be successful, which contributes to the failure rate. Greater provision of cord blood could help patients get treatment faster and improve the chances of survival.
	Greater provision of cord blood would give many who currently have no bone marrow donor a potentially life-saving option. The baby’s blood that is left behind in the umbilical cord contains many different types of cells, and some of them are stem cells, which have been shown to have a number of medical applications. Over the past 20 years, collected cord blood has been used for transplantation in the same way as bone marrow, so we can square the circle and see the advantages of drawing attention to the benefits of collecting cord blood and requiring the Secretary of State to ensure that this is done consistently and banked accordingly.
	Researchers believe that cord blood has the potential to treat many more diseases once adult stem cells are properly understood. Trials have shown that cord blood may be helpful in treating brain injuries in children. It has also been developed for other possible treatments, including for testicular cancer, multiple sclerosis and diabetes, and for regenerating damaged heart cells. The potential is exciting, therefore. It is particularly valuable in the treatment of leukaemia. It can be used as an alternative to bone marrow transplantations.
	Collection of umbilical cord blood is a far less invasive procedure than extracting bone marrow, and the units can be collected, frozen and stored for years, which leads to fewer complications and makes transplants more readily available than for bone marrow. More importantly, it is easier to find matching stem cells from cord blood than from bone marrow. If we can develop a proper infrastructure for the collection and storage of cord blood, that will do much to alleviate the severe shortage of life-saving stem cells.

David Burrowes: Is it not also important to ensure, through the Bill or other means, that commissioners are able to make the right decisions? Evidence of some commissioners questioning the economic value of
	proceeding with stem cell transplants was brought before the all-party group on stem cell transplantation. It is important that we pursue commissioning excellence.

Nick de Bois: I understand that the UK Stem Cell Strategic Forum recommended to the Government that there should be a regional centre of excellence, and I hope Ministers will let us know by letter if that policy is indeed being pursued, as I think it might deal with the issue that my hon. Friend raises.
	Cord blood is a natural, safe, ethical and sustainable resource, and it offers many advantages over using traditional bone marrow transplants. We in this country should be proud that the NHS was one of the first bodies to recognise the potential importance of cord blood and significant breakthroughs were made in Britain. In 1996 an NHS cord bank was established, which is now working alongside the Anthony Nolan trust. At a time when the health service is mindful of the need to inform patients fully about their health care, the issue of the collection of a mother-baby’s cord blood does not seem to get the same degree of attention. The principles of full information and consent do not seem to apply to cord blood, which is, in general, treated as a waste product, unbeknown to parents, apart from in exceptional circumstances. By agreeing to my amendments, we can change that situation and the Government can demonstrate that they are giving a lead in the dissemination of information to expectant parents.
	Last year academic research said that in order to have a truly effective operation we should strive to obtain 50,000 units of cord blood. I congratulate the Government, who have already committed £4 million to reach the first benchmark of 20,000 cord blood units. I commend the work of the Anthony Nolan trust and the NHS, which have also been sharing in building up to this target. Of course this is only the start, and I know that the Government have already expressed their commitment to helping to develop this very important work.
	We have an opportunity for more lives to be saved, for valuable scientific research to be undertaken and for the UK to become a centre of excellence in cord blood. We can avoid the current situation whereby every day two people die waiting for a stem cell transplant, and 65,000 litres of cord blood are discarded every year. I welcome the Minister’s words of support and I appreciate the sentiments behind the Government’s thinking. I urge them to continue to get behind this valuable cause.

Rushanara Ali: I speak in support of amendment 1169, which seeks to strengthen the Secretary of State’s duty to reduce health inequalities. As presented in clause 3, the Secretary of State’s duty is insufficient to tackle the health inequalities in our society. The clause lacks strength, invites the Secretary of State to disregard its meaning and changes little in the way in which health inequalities will be tackled in the future. By supporting amendment 1169 we can ensure that the Secretary of State can be regularly and properly held to account for his duty to tackle health inequalities across England.
	Tackling health inequalities is vital because this is, in many cases, a matter of life and death. The World Health Organisation’s Commission on Social Determinants of Health has said:
	“Social justice…affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in
	wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.”
	In our own country, Bevan’s dream for the NHS was for a service in which:
	“No longer will wealth be an advantage nor poverty a disadvantage.”
	Yet, despite the great strides that have been made there is much more to do, and the link between poverty and poor health remains.

Sarah Wollaston: Will the hon. Lady give way?

Rushanara Ali: As there is not much time left, I would like to proceed in order to allow other colleagues to speak.
	That link can be seen as clearly in London as anywhere else. According to the London health inequalities strategy,
	“for men, life expectancy at ward level ranges from 71 years in Tottenham Green ward in Haringey to 88 years in Queen’s Gate ward in Kensington and Chelsea—a span of seventeen years”.
	Despite the progress made nationally, in the borough of Tower Hamlets, in which my constituency sits, the rate of heart disease or stroke before the age of 75 is more than twice that of a more affluent area such as Surrey, and early cancer rates are nearly 50% higher.
	We know that with the right resources and leadership it is possible to reduce health inequalities. In the past 10 years, the rates of early death from cancer and from heart disease and stroke have fallen in my constituency, but they remain worse than those in other parts of the country. That is why it is vital that for the Secretary of State to continue the focus on tackling health inequalities, for us to look at the cross-cutting issues affecting health and for there to be co-ordination across government, led by the Health Secretary.
	Tackling health inequalities was central and integral to Labour’s policy making in government. I urge this Government to think again, to recognise the vital importance of continuing that commitment and to make sure that there is genuine accountability for reducing health inequalities.
	I was saddened to see last month that the Government plan to reduce the funding allocated to tackling health inequalities by altering the weighting given to inequalities in the weighted capitation formula from 15% to 10%. That will lead to a reduction in funding of £20 million over the next three years in Tower Hamlets—

Ben Gummer: Will the hon. Lady give way?

Rushanara Ali: I will not give way, because there is not much time left.
	The borough is one of the poorest in the country, with high levels of health inequalities, and the change will have a direct and damaging effect on the health of my constituents and many others around the country.

Andrew Lansley: rose —

Rushanara Ali: I will not give way, because the Secretary of State has had long enough to speak. He has had far too long to speak, and I have two minutes left.
	The change will have a very damaging effect on my constituents, and if the formula is applied across the country it will increase inequality. I ask the Secretary of State again to show leadership and take responsibility—

Andrew Lansley: rose —

Rushanara Ali: The Secretary of State has spoken for long enough—[ Interruption. ] He has spoken, but there has not been much content—[ Interruption. ]

Dawn Primarolo: Order. The hon. Lady is entitled to make her speech and to be heard in this Chamber. As all Members know, this debate ends at 6 o’clock and there are still quite a few Members who have been present all the time who wish to speak.

Rushanara Ali: Thank you, Madam Deputy Speaker.
	Amendment 1169 would be of great benefit in tackling health inequalities. It would make a real difference to people’s lives. Requiring the Secretary of State to lay an annual report before Parliament on progress towards ending health inequalities is therefore key in ensuring that proper accountability continues to exist. What is he afraid of? He could see the impact and put in place mechanisms to continue to improve, learning from the evidence and making progress. Considering how we can reduce inequalities in constituencies such as mine is a constructive way forward. I call on the Secretary of State to think again and accept this sensible amendment.
	In conclusion, as the Marmot review stated, the
	“link between social conditions and health is not a footnote to the ‘real’ concerns with health…it should become the main focus.”
	Tackling health inequalities should be a central aim of health care policy for any Government, and the amendment would be crucial for achieving that. I hope that Members on both sides will back it and that the Secretary of State will take note.

Margot James: I want to support the leadership that the Bill ascribes to public health and the role of the patient and empowered individual in taking responsibility for their health care as far as is possible. I congratulate the Government on setting public health free, as I see it, and taking it out of its ivory tower. It has been in the preserve of the primary care trusts and although in some PCTs it is given life, in others it gathers dust and is vulnerable to financial raids from time to time as budget pressures build and people seek to take money from an area where the public do not necessarily see the results for a fairly long time and to give it in preference to things that cause short-term pain. Regardless of which party has been in government, that has always been the case with public health.
	If we consider where public health can make a difference in preventing ill health, we can see that the future of the NHS depends on a much better preventive strategy. Perhaps the best thing that the previous Government did in health care policy was the smoking ban, which will probably save more lives in the long run than anything else. We could consider some of the other areas that are ripe for similar treatment. I do not mean that we should ban alcohol, but we could consider public health policy and what it could do to reduce the incidence of sexually transmitted diseases, HIV,
	alcohol abuse and mental health problems. Many of the issues to do with drugs are about education and prevention, too.
	I am pleased to see links being built into other aspects of the Bill. Our proposals for public health in relation to mental health have been strongly welcomed by the Samaritans, because there is so much to do with mental health that takes place in the community. The involvement of local authorities and the leadership role given to them in the Bill should enable aspects of local government policy such as housing, children’s social services and adult and social care to be brought to bear in dealing with these problems.

Sarah Newton: Will my hon. Friend give way?

Margot James: I would love to but I am aware that others are waiting and I am trying to curtail my comments. [Hon. Members: “Hear, hear!] I will take that as a prompt to get a move on.
	I want to address a point that was made earlier about where the director of public health should sit in a local authority. I think it is important that the public health director should report to the chief executive because the public health function will cover so much that is part of children’s services, adult and social care and housing that it is hard to see how they will fit in unless they report at the top level.
	In conclusion, I believe that the elevation of public health will enable public health to be placed at the centre of commissioning and that the link between the wellbeing boards and the primary care commissioning groups will enable public health to be instrumental within commissioning. That is where we will see the long-term benefits outrunning the short-term imperatives.

Alison Seabeck: I shall cut to the chase because other Members want to speak and many colleagues have spoken powerfully about the benefits of the NHS. I have two very specific questions regarding concerns that people in the south-west have raised with me. These issues relate to part 1 of the Bill, the role of the director of public health, and the making of complaints, as covered by new clause 1. I want to link these issues to the duty of the Secretary of State to ensure that the basis on which actions are taken—indeed, the information that is used—is in the hands of and is accessible to people in the new set-ups who need that information and can use it.
	The concerns that have been raised with me relate to the movement of national health service public health staff into local authority control and the fact that the Office for National Statistics currently has a duty to release certain data only to directors of public health, who are part of the NHS. I gather that the ONS has had concerns about this and I am interested to know whether it has waived the requirement for directors of public health to sign a confidentiality and proper use statement every year, or whether it has agreed to the passing of this role into local authorities. I cannot find that in the Bill, although I must admit that I am coming to this a little late—my apologies to colleagues about that—and I would be very grateful if the Minister could tell me whether that issue has been resolved.
	Secondly, the Minister will know that we carry out nuclear decommissioning in Plymouth. Is he confident that public health can be fully protected in the way that it has been in the past? I note clause 54 on radiation, but will the Minister look at how H1N1 was dealt with? The first confirmed case of swine flu was in Paignton and the response was carried out by PCT public health staff in Plymouth and Torbay. They worked together rapidly to administer antiviral drugs to nearly 500 pupils and they provided reassurance and support to extremely anxious children and parents. That response was set up within 45 minutes of the initial phone call, despite the fact that it had not been done before, and it was done without any practical help from the Health Protection Agency, which was swamped with other work. The PCT public health staff just got on with it and they did a fantastic job—no other child was infected. Indeed, they compiled a guide on how to do it all, which was passed on and was commended by the Prime Minister. There is a view that such a response will not be possible in a few years’ time, so complaints from the public—this takes us back to new clause 1—will inevitably follow. Clearly, if we get health protection wrong, we can kill people.
	In order to avoid complaints on new clause 1, will the Minister say what power the director of public health, sitting within the local authority, will have to galvanise staff across organisations? Will they be the appropriate authority, or will responsibility sit elsewhere? Will they have to go through another senior officer? Who is ultimately responsible if they get it badly wrong—the local authority, the director of public health or the Secretary of State? Or is it another instance when the Government are saying, “Not me, guv” and passing the buck to the local council and the political leadership of that council? If there was a viral outbreak in various parts of the country, widely spread, would the individual local authorities be held responsible for dealing with it, coming up with solutions and coping with the outcomes, or is this a case in which the Secretary of State actually has a clear duty to take the lead?

Martin Horwood: I am extremely grateful to you for calling me, Madam Deputy Speaker, as you have a tough job this afternoon. I have to declare an interest. I rarely speak in the House on NHS organisation, particularly public health, because my wife is employed as a director of public health. Obviously, the Bill and the public health section of clause 27 will affect her significantly, and by extension those of us in her family, but I make it clear to the House that although my knowledge of her role and profession has informed amendments 1255 to 1260, which stand in my name, she had no knowledge of them or their contents before I tabled them. However, I am grateful to the Faculty of Public Health and others who have given me advice.
	Public health is pretty poorly understood, not least in this Chamber at times. There is a constant tendency to confuse it with the traditional, established local authority function of environmental health, and although I have great respect for the hon. Member for Stoke-on-Trent North (Joan Walley) in many respects, I think the risk of her new clause 23 is that it extends that confusion between environmental health and public health. There are many key functions to public health, not just the vital five-a-day style health promotion and health improvement work, but a critical role in health protection, including the management of outbreaks of communicable
	diseases—serious diseases such as meningitis and influenza—and a key role in influencing, at the moment, NHS commissioning at local level, using population-wide data and medical analysis. That, at the moment, happens very simply and straightforwardly within the primary care trust. Under the Bill at the moment, there is no role for the director of public health within the new clinical commissioning groups, and they have to exercise that kind of influence at several removes. That point was well made by the hon. Member for Plymouth, Moor View (Alison Seabeck).
	It was suggested to me at one stage by some civil servants working on the Bill that in order to make up for the gap left by the director of public health in the new clinical commissioning groups—then called consortia—they might actually want to employ someone with public health expertise to make up for the reorganisation. That does not seem to me a very good use of public money.
	Some of the things that Ministers have announced are to be welcomed. I will have to skip over them briefly, but principal among them is the very good decision to make Public Health England a separate Executive agency and not part of the Department of Health. That was a key request of the faculty, and I think it is very important that it retain that status and objectivity.
	I pay tribute to the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), for taking a great deal of time and care over the concerns that I had in this whole area, but questions remain to be addressed and my six amendments are an attempt to address three main areas.
	The first area is, as the hon. Member for Plymouth, Moor View pointed out, that under this scheme directors of public health will be removed from the NHS, as will their staff. One of my amendments suggests, therefore, that they should continue to be employed by Public Health England and retain that integration within a wider public health profession. At the moment directors of public health sit within primary care trusts and it is reasonably straightforward, but within the spaghetti-like structures created by the Bill, public health responsibilities and leadership are now to be split among Public Health England, the Secretary of State, the local authorities, the national commissioning board, the health and wellbeing boards and clinical commissioning groups. The threat is not just confusion and the unclear fragmentation of public health functions, but the fragmentation of the profession itself and of the career paths, whereby people might move from one bit to another and have to leave and rejoin the NHS, and so on. That is one of the issues addressed.
	The second issue is that people should be suitably qualified. The responsibility for their professional qualification and professional development should lie in the hands of Public Health England, not local authority managers, who might have no medical or professional public health training. It is an important function, so they should be senior officers. Several members of the Health Committee, including its Chair, made the important point that they should report directly to the chief executive. It has been suggested in some parts of the country that the post of director of public
	health could be combined with or report to other directorates in the principal local authority—for instance, the director of housing.
	I wrote to the Deputy Prime Minister on the issues, and he replied:
	“given the importance of these new local authority public health functions, the leadership position of the DPH in the local community and the critical health protection functions to be carried out by the DPH on behalf of the local authority, we would expect the DPH to be of chief officer status”.
	I do not think that an expectation is strong enough. I have great regard for many directors of housing, but if my child had meningitis, I would not want the director of housing to be on the other end of the phone line at a critical moment.
	As it is still possible for the Government to address these issues through the consultation exercise on public health that is being planned, I will not press my amendments to a vote today, but I was rather disappointed with the Minister’s response to them. Should any noble Friends be listening from the Gallery, I hope they might take up the theme of public health in another place. Public health is poorly understood and has not grabbed the headlines in the way that the 38 Degrees campaign has, but over recent years it has been quietly becoming a more and more successful, professional and increasingly medically qualified discipline in the NHS. It saves lives, and we should protect it.

Paul Burstow: We have had a full and wide-ranging debate on the many issues covered by this group of amendments. I want to try to pick up a few of the key questions that have been asked. The Bill will increase the Secretary of State’s accountability for a comprehensive health service.

William Cash: Will the Minister give way?

Paul Burstow: No, not at all.
	The Bill will provide all the powers and duties necessary: the duty to keep the health service’s functions under review, a duty to report annually on the health service’s performance and a duty to consult on the board’s mandate and to lay it before Parliament and to lay regulations about how commissioners carry out their functions. All those things are new. They are more than backstops; they are guarantees of a comprehensive health service being secured and the Secretary of State maintaining his accountability to the House and Members of Parliament for that purpose.
	I have already made it clear to those who are concerned about clause 4 and the possibility, which we do not accept, that it will lead to a hands-off approach that we are willing to listen to and consider the concerns that have been raised and make any necessary amendment to put it beyond doubt that the Secretary of State remains responsible and accountable for a comprehensive health service, which we all want to see.
	There has been talk about a postcode lottery. Indeed, the Bill sets out, through the work of the NHS commissioning board, to ensure that the postcode lottery that we inherited from the last Government is something that we can make a thing of the past, as a consequence of the changes that the Bill will introduce.
	The hon. Member for Stoke-on-Trent North (Joan Walley) made some important points about environmental health officers and the contribution they make locally and nationally. Although we see the chief medical officer having a key role in providing such advice, I would be happy for us to carry on discussions about how we can further strengthen that role nationally.
	As the consultations on the issues raised today by my hon. Friend the Member for Cheltenham (Martin Horwood) carry on, I am certainly happy to discuss with him how we can address those concerns. I can assure him that, because the Secretary of State will be directly involved in the appointment process for directors of public health through Public Health England’s role, they will be able to assure themselves that they are adequately qualified.

William Cash: Will the Minister give way?

Paul Burstow: No.
	The Bill has been changed because the Government have been listening carefully. We have acted on the NHS Future Forum’s recommendations.
	Our goals are clear in this Bill: they are to place patients at its heart, ensure that the service is clinically led and ensure that it is focused on driving up quality and outcomes.
	Question put and agreed  to .
	New clause 1 accordingly read a Second time, and added to the  Bill .
	Proceedings interrupted (Programme Order, 6  September ).
	Madam Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

New Clause 7
	 — 
	Other dissemination of information

‘(1) The Information Centre may disseminate (other than by way of publication), to any such persons and in such form and manner and at such times, as it considers appropriate any information—
	(a) which it collects pursuant to a direction under section257 or a request under section258, and
	(b) which falls within subsection (2).
	(2) Information falls within this subsection if—
	(a) the information is required to be published under section 262;
	(b) the information is in a form which identifies any relevant person to whom the information relates or enables the identity of such a relevant person to be ascertained and the Centre, after taking into account the public interest as well as the interests of the relevant person, considers that it is appropriate for the information to be disseminated;
	(c) the Centre is prohibited from publishing the information only by virtue of it falling within section 262(2)(c) and the Centre considers it would be in the public interest for the information to be disseminated;
	(d) the Centre is prohibited from publishing the information only by virtue of a direction given under section 262(2)(d) and that direction provides that the power in subsection (1) applies to the information.
	(3) A direction under section 262(2)(d) may require the Information Centre to disseminate information which the Centre is prohibited from publishing only by virtue of the direction.
	(4) A direction under section 257 may require, and a request under section 258 may request, the Information Centre to exercise—
	(a) the power conferred by subsection (1) in relation to information which it collects pursuant to the direction or request, or
	(b) any other power it has to disseminate such information under or by virtue of any other provision of this or any other Act.
	(5) A direction under section 257 may require, and a request under section 258 may request, the Information Centre not to exercise the power conferred by subsection (1) in relation to information which it collects pursuant to the direction or request.
	(6) Nothing in this section prevents the Information Centre from disseminating information (otherwise than by publishing it) pursuant to the exercise of any function conferred by or under any other provision of this or any other Act.
	(7) A requirement imposed on, or a request made to, the Information Centre in accordance with this section to disseminate information may include a requirement or request about the persons to whom the information is to be disseminated and the form, manner and timing of dissemination.’.—(Paul  Burstow .)
	Brought up, and added to the Bill.

New Clause 8
	 — 
	Subsequent property transfer schemes

‘(1) This section applies in relation to any property, rights or liabilities which are transferred under a property transfer scheme under section 299(2) from a Primary Care Trust, a Strategic Health Authority or the Secretary of State to a Special Health Authority or a qualifying company.
	(2) The Secretary of State may make a scheme for the transfer of any such property, rights or liabilities from the Special Health Authority or the qualifying company to any body or other person mentioned in the second column of Schedule 23.
	(3) Subsections (1) to (4) and (6) of section 300 apply in relation to a scheme under subsection (2) as they apply in relation to a property transfer scheme under section 299(2).’.—(Paul  Burstow .)
	Brought up, and added to the Bill.

New Clause 9
	 — 
	Commencement: consultation with Scottish Ministers

‘(1) The Secretary of State must consult the Scottish Ministers before making an order under section 304(4) relating to—
	(a) section 54 (radiation protection functions), so far as relating to the Scottish Ministers,
	(b) section 56 (co-operation in relation to public health functions), so far as relating to the exercise of functions in relation to Scotland by a person to which the provision inserted by subsection (1) of that section applies,
	(c) section 226(4) (requirement for persons advised etc. by the Professional Standards Authority for Health and Social Care to pay fee), so far as relating to the Scottish Ministers,
	(d) section 227(1) (funding of the Professional Standards Authority for Health and Social Care), so far as relating to a body that regulates a profession in Scotland which does not fall within Section G2 of Part 2 of Schedule 5 to the Scotland Act 1998 (health professions),
	(e) section 227(4) and (5) (power of the Professional Standards Authority for Health and Social Care to borrow), so far as relating to functions of the Professional Standards Authority for Health and Social Care which are exercisable in relation to—
	(i) unregulated health professionals in Scotland, unregulated health care workers in Scotland or relevant students in Scotland,
	(ii) a body that maintains a register of persons within sub-paragraph(i),
	(iii) a profession in Scotland which does not fall within Section G2 of Part 2 of Schedule 5 to the Scotland Act 1998, or
	(iv) a body that regulates a profession within sub-paragraph (iii),
	(f) section 228(1) (power of the Professional Standards Authority for Health and Social Care to advise regulatory bodies etc.), so far as relating to a body that regulates a profession in Scotland which does not fall within Section G of Part 2 of Schedule 5 to the Scotland Act 1998 (architects, health professions and auditors),
	(g) section 229(8) (requirement for the Professional Standards Authority for Health and Social Care to lay copy strategic reports before Parliament etc.), so far as relating to the Scottish Parliament,
	(h) section 230 (appointments to regulatory bodies), so far as relating to—
	(i) the exercise of the appointment functions under subsection (8)(f) of the provision inserted by that section, or
	(ii) subsection (4) of that provision,
	(i) section 231 (establishment of voluntary registers), so far as relating to the establishment and maintenance of relevant registers,
	(j) section 232 (accreditation of voluntary registers), so far as relating to the functions of the Professional Standards Authority for Health and Social Care in relation to relevant registers,
	(k) Part 2 or 3 of Schedule16 (amendments relating to the Health and Care Professions Council or the Professional Standards Authority for Health and Social Care) and section 233(1) so far as relating to the Part in question, and
	(l) paragraphs 1 to 4 of Schedule22 (amendments of the National Health Service (Scotland) Act 1978 relating to the relationships between the health services) and section296 so far as relating to those paragraphs.
	(2) In this section—
	“relevant registers” means—
	(a) registers of unregulated health professionals in Scotland,(b) registers of unregulated health care workers in Scotland, or(c) registers of relevant students in Scotland,
	“relevant students in Scotland” means persons participating in studies in Scotland for the purpose of becoming—
	(d) an unregulated health professional,(e) an unregulated health care worker, or(f) a member of a profession which does not fall within Section G2 of Part 2 of Schedule 5 to the Scotland Act 1998,
	“unregulated health professional” means a person who is or has been practising as an unregulated health professional (within the meaning of the provisions inserted by section 231) and “unregulated health professional in Scotland” means a person who is or has been practising as such in Scotland, and
	“unregulated health care worker” means a person who is or has been engaged in work as an unregulated health care worker (within the meaning of those provisions) and “unregulated health care worker in Scotland” means a person who is or has been engaged in such work in Scotland.’.—(Paul Burstow.)
	Brought up, and added to the  Bill .

Clause 1
	 — 
	Secretary of State’s duty to promote comprehensive health service

Amendment proposed: 1176,page2,line7, leave out subsection (2) and insert—
	‘(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.’.—(Owen Smith.)
	Question  put, That the amendment be made.
	The House divided:
	Ayes 255, Noes 304.

Question accordingly negatived.
	Clause 14
	Other services etc. provided as part of the health service
	Amendment made: 49,page9,line12, leave out subsection (7).—(Mr Lansley.)
	Clause 15
	Regulations as to the exercise by local authorities of certain public healthfunctions
	Amendments made: 50,page11,line24, at end insert—
	‘( ) Where regulations under subsection (1) require a local authority to exercise any of the public health functions of the Secretary of State, the regulations may also authorise or require the local authority to exercise any prescribed functions of the Secretary of State that are exercisable in connection with those functions (including the powers conferred by section 12).’.
	Amendment 51,page11,line27, at end insert—
	‘( ) Any rights acquired, or liabilities (including liabilities in tort) incurred, in respect of the exercise by a local authority of any of its functions under regulations under subsection (1) are enforceable by or against the local authority (and no other person).’.—(Mr Lansley.)
	Clause 16
	Regulations relating to EU obligations
	Amendments made: 52,page12,line6, at end insert—
	‘( ) The making of regulations under subsection (1) does not prevent the Secretary of State from exercising the specified EU health function.’.
	Amendment 53,page12,line6, at end insert—
	‘( ) Any rights acquired, or liabilities (including liabilities in tort) incurred, in respect of the exercise by the Board or a clinical commissioning group of any of its functions under regulations under subsection (1) are enforceable by or against the Board or (as the case may be) the group (and no other person).’.—(Mr Lansley.)
	Clause 19
	Exercise of public health functions of the Secretary of State
	Amendment made: 54,page14,line37, at end insert—
	‘( ) Any rights acquired, or liabilities (including liabilities in tort) incurred, in respect of the exercise by a body mentioned in subsection (2) of any function exercisable by it by virtue of this section are enforceable by or against that body (and no other person).’.—(Mr Lansley.)
	Clause 20
	The NHS Commissioning Board: further provision
	Amendments made: 55,page16, leave out lines 28 and 29.
	Amendment 56,page17, leave out lines 27 and 28.
	Amendment 57,page17, leave out lines 33 and 34.
	Amendment 58,page17, leave out lines 39 and 40.
	Amendment 59,page18, leave out lines 14 and 15.
	Amendment 60,page18, leave out lines 42 to 44 and insert—
	“(3) The Board must encourage clinical commissioning groups to enter into arrangements with local authorities in pursuance of regulations under section 75 where it considers that this would secure—
	(a) that health services are provided in an integrated way and that this would have any of the effects mentioned in subsection (1)(a) to (c), or
	(b) that the provision of health services is integrated with the provision of health-related services or social care services and that this would have any of the effects mentioned in subsection (2)(a) to (c).’.
	Amendment 61,page19, leave out lines 1 and 2.
	Amendment 62,page19, leave out lines 19 and 20.
	Amendment 63,page19,line32, at end insert ‘in the exercise of its functions’.
	Amendment 64,page20, leave out lines 3 and 4.
	Amendment 65,page24,line20, at end insert—
	‘“health services” means services provided as part of the health service and, in sections 13N and 13P, also includes services that are to be provided as part of the health service’.
	Amendment 66,page24,line20, at end insert—
	‘(2) Any reference (however expressed) in the following provisions of this Act to the functions of the Board includes a reference to the functions of the Secretary of State that are exercisable by the Board by virtue of arrangements under section 7A—
	(a) section 6E(7) and (10)(b),
	(b) section 13A(2),
	(c) section 13C(1),
	(d) section 13D,
	(e) section 13E(1),
	(f) section 13F,
	(g) section 13G(1),
	(h) section 13H(1),
	(i) section 13I(1),
	(j) section 13J,
	(k) section 13K(1),
	(l) section 13L,
	(m) section 13M(1) and (2),
	(n) section 13N(2),
	(o) section 13P(1),
	(p) section 13S(1),
	(q) section 13T(1) and (4),
	(r) section 13V(2),
	(s) section 13W(1),
	(t) section 13Z1(1),
	(u) section 13Z2(1),
	(v) section 72(1),
	(w) section 75(1)(a) and (2),
	(x) section 82,
	(y) section 223C(2)(a),
	(z) in Schedule A1, paragraph 13.
	(3) Any reference (however expressed) in the following provisions of other Acts to the functions of the Board includes a reference to the functions of the Secretary of State that are exercisable by the Board by virtue of arrangements under section 7A—
	(a) sections 116 to 116B of the Local Government and Public Involvement in Health Act 2007 (joint strategic needs assessments etc.),
	(b) section 200(6) of the Health and Social Care Act 2011 (participation of the Board in work of Health and Wellbeing Boards),
	(c) section 202(4) of that Act (supply of information to Health and Wellbeing Boards),
	(d) section 289(1) and (2) of that Act (duties to co-operate),
	(e) section 290(2)(d) of that Act (breaches of duties to co-operate).
	(4) The Secretary of State may by order amend the list of provisions specified in subsection (2) or (3).”’.—(Mr Lansley.)

Clause 21
	 — 
	Financial arrangements for the board

Amendments made: 67,page24,line38, after ‘change,’, insert—
	‘() a parliamentary general election takes place,’.
	Amendment 68,page26,line13, after ‘change,’, insert—
	‘() a parliamentary general election takes place,’.—(Mr Lansley.)
	Clause 22
	Commissioning consortia: establishment etc.
	Amendments made: 69,page27,line31, leave out ‘of services’.
	Amendment 70,page32,line3, leave out ‘and’ and insert—
	‘() the function of determining the allowances payable under a pension scheme established under paragraph 10(4) of Schedule 1A, and’.
	Amendment 71,page32, leave out lines 13 and 14.—(Mr Lansley.)
	Clause 23
	Commissioning consortia: general duties etc.
	Amendments made: 72,page34, leave out lines 14 and 15.
	Amendment 73,page35, leave out lines 8 and 9.
	Amendment 74,page35, leave out line 19.
	Amendment 75,page35, leave out line 24.
	Amendment 76,page35, leave out lines 39 and 40.
	Amendment 77,page36, leave out lines 28 and 29.
	Amendment 78,page36,line41, after ‘consortium’, insert
	‘in the exercise of its functions’.
	Amendment 79,page37, leave out lines 21 and 22.
	Amendment 80,page47,line14, at end insert—
	‘“health services” means services provided as part of the health service and, in section 14Z, also includes services that are to be provided as part of the health service.’.
	Amendment 81,page47,line14, at end insert—
	‘(2) Any reference (however expressed) in the following provisions of this Act to the functions of a clinical commissioning group includes a reference to the functions of the Secretary of State that are exercisable by the group by virtue of arrangements under section 7A—
	(a) section 6E(7) and (10)(b),
	(b) section 14C(2)(e),
	(c) section 14O,
	(d) section 14P,
	(e) section 14S(1),
	(f) section 14T(1),
	(g) section 14U(1),
	(h) section 14V(1),
	(i) section 14W(1),
	(j) section 14X,
	(k) section 14Y(1) and (2),
	(l) section 14Z(1),
	(m) section 14Z2(1),
	(n) section 14Z3(2),
	(o) section 14Z4(1),
	(p) section 14Z5(7),
	(q) section 14Z9(1),
	(r) section 14Z13(1),
	(s) section 14Z14(2),
	(t) sections 14Z15(1), 14Z17(1) and 14Z19(1) and (3),
	(u) section 14Z21(1),
	(v) section 72(1),
	(w) section 75(1)(a) and (2),
	(x) section 77(1)(b),
	(y) section 82,
	(z) section 89(1A)(d),
	() section 94(3A)(d),
	() section 223C(2)(b),
	() section 223H(1),
	() in Schedule 1A, paragraphs 3(1) and (3), 5, 11(6)(b) and 13(3).
	(3) Any reference (however expressed) in the following provisions of other Acts to the functions of a clinical commissioning group includes a reference to the functions of the Secretary of State that are exercisable by the group by virtue of arrangements under section 7A—
	(a) sections 116 to 116B of the Local Government and Public Involvement in Health Act 2007 (joint strategic needs assessments etc.),
	(b) section 202(4) of the Health and Social Care Act 2011 (supply of information to Health and Wellbeing Boards),
	(c) section 290(2)(d) of that Act (breaches of duties to co-operate).
	(d) in Schedule 6 to that Act, paragraph 5(4).
	(4) The Secretary of State may by order amend the list of provisions specified in subsection (2) or (3).”’.—(Mr Lansley.)
	Clause 24
	Financial arrangements for consortia
	Amendment made: 82,page50,line32, leave out ‘or 12’.—(Mr Lansley.)

Clause 29
	 — 
	Abolition of Strategic Health Authorities

Amendment proposed: 7,page54,line30, at end insert—
	‘(3) This section comes into force on a date to be specified by order by the Secretary of State.
	(4) The time specified in subsection (3) must be after such time as the Secretary of State is satisfied that the workforce education and training functions of strategic health authorities are being fulfilled by another body.’.—(Owen Smith.)
	Question put, That the amendment be made.
	The House divided:
	Ayes 240, Noes 318.

Question accordingly negatived.

Clause 42
	 — 
	Role of the Board and consortia in respect of emergencies

Amendments made: 83,page73,line31, at end insert—
	‘(7A) Where the Board makes arrangements with another body or person under subsection (7) it may also arrange for that other body or person to exercise any functions that the Board has, by virtue of being a Category 1 responder, under Part 1 of the Civil Contingencies Act 2004.’.
	Amendment 84,page74,line8, leave out from ‘made’ to end of line 9 and insert
	‘by the Board or a clinical commissioning group under or by virtue of section 3, 3A, 3B, 4 or 7A or Schedule 1.’—(Mr Lansley.)

Clause 43
	 — 
	Secretary of State’s emergency powers

Amendments made: 85,page74,line20, after ‘person’, insert ‘, other than an NHS body,’.
	Amendment 86,page74,line21, leave out from ‘made’ to end of line 23 and insert ‘—
	(i) by the Secretary of State under section 12,
	(ii) by the Board or a clinical commissioning group under section 3, 3A, 3B or 4 or Schedule 1,
	(iii) by a local authority for the purpose of the exercise of its functions under or by virtue of section 2B or 6C(1) or Schedule 1, or
	(iv) by the Board, a clinical commissioning group or a local authority by virtue of section 7A.’.—(Mr Lansley.)

Clause 184
	 — 
	Healthwatch England

Amendments made: 221,page169,line28, leave out ‘or assistance’ and insert ‘, information or other assistance’.
	Amendment 222,page171,line12, after ‘(1)(b)’ insert ‘or (3)’.—(Mr Lansley.)

Clause 185
	 — 
	Establishment and constitution

Amendments made: 223,page172,line30, at end insert—
	‘( ) In section 229 (sections 221 to 228: interpretation and supplementary)—
	(a) in the title and in subsection (1), for “221” substitute “220A”, and
	(b) in subsection (2), after “228” insert “or Schedule 16A”.’.
	Amendment 224,page172,line40, at end insert—
	‘( ) In Part 2 of Schedule 1 to the Freedom of Information Act 2000 (local government), after paragraph 35C insert—
	“35D A Local Healthwatch organisation.”’.—
	(Mr Lansley.)

Clause 188
	 — 
	Independent advocacy service

Amendments made: 225,page175,line4, at end insert ‘in relation to its area’.
	Amendment 226,page175,line22, after ‘services’ insert ‘in relation to its area’.
	Amendment 227,page176,line4, at end insert—
	‘(9A) The Secretary of State may give directions to a local authority about the exercise of its functions under this section.
	(9B) A direction under subsection (9A) may be varied or revoked.’.—(Mr Lansley.)

Clause 189
	 — 
	Requests, rights of entry and referrals

Amendments made: 228,page176,line42, after second ‘organisation’ insert ‘—
	(a) ’.
	Amendment 229,page176,line44, after ‘221(2)’ insert ‘, or
	(b) for the purposes of subsection (1)(a) only, in the discharge of its duty under paragraph 6(5) of Schedule 16A.’.
	Amendment 230,page176,line45, leave out subsection (4) and insert—
	‘(4) In the title to that section, for “local involvement networks” substitute “Local Healthwatch organisations”.’.—(Mr Lansley.)

Clause 193
	 — 
	Scrutiny functions of local authorities

Amendments made: 231,page180,line16, leave out ‘NHS providers’ and insert ‘health service providers’.
	Amendment 232,page180,line18, leave out ‘NHS provider’ and insert ‘health service provider’.
	Amendment 233,page180,line21, leave out ‘NHS provider’ and insert ‘health service provider’.
	Amendment 234,page180,line22, leave out ‘NHS provider’ and insert ‘health service provider’.
	Amendment 235,page180,line25, leave out ‘NHS providers’ and insert ‘health service providers’.
	Amendment 236,page181,line12, at end insert—
	‘( ) Any functions conferred on a local authority by regulations under this section are not to be the responsibility of an executive of the authority under executive arrangements (within the meaning of Part 1A of the Local Government Act 2000).’.
	Amendment 237,page181,line18, after ‘body”’, insert ‘, in relation to an authority to which this section applies,’.
	Amendment 238,page181,line21, leave out ‘NHS provider”’ and insert ‘health service provider”, in relation to an authority to which this section applies,’.
	Amendment 239,page181,line21, leave out from ‘which’ to ‘is’ in line 23 and insert ‘—
	(a) provides services in pursuance of arrangements made—
	(i) by the Board or a clinical commissioning group under section 3, 3A, 3B or 4 or Schedule 1,
	(ii) by a local authority for the purpose of the exercise of its functions under or by virtue of section 2B or 6C(1) or Schedule 1, or
	(iii) by the Board, a clinical commissioning group or a local authority by virtue of section 7A, and
	(b) ’.
	Amendment 240,page181, leave out lines 27 to 31 and insert—
	‘(3A) In subsection (2)(f) “member”—
	(a) in relation to a clinical commissioning group, includes a person who is not a member of the group but is a member of a committee or sub-committee of it;
	(b) in relation to a relevant health service provider which is a body corporate, includes a person who is not a member of the body but is a director of it;
	(c) in relation to an NHS trust, means a director of the trust;
	(d) in relation to an NHS foundation trust, means a director or governor of the trust.
	(3B) For the purposes of subsection (2)(f)—
	(a) a member of a body which is a member of a clinical commissioning group or relevant health service provider is to be treated as a member of the group or (as the case may be) relevant health service provider, and
	(b) an employee of a body which is a member of a clinical commissioning group or relevant health service provider is to be treated as an employee of the group or (as the case may be) relevant health service provider.”’.—(Mr Lansley.)

Clause 226
	 — 
	Functions of the Authority

Amendments made: 241,page212,line21, at end insert—
	‘( ) In subsection (3) of that section, after “this section” insert “—
	“health care profession” means a profession (whether or not regulated by or by virtue of any enactment) which is concerned (wholly or partly) with the physical or mental health of individuals; and”.’.
	Amendment 242,page212,line24, at end insert—
	‘( ) In section 27 of that Act (the Authority and regulatory bodies), in subsections (5) and (13), for “Secretary of State” substitute “Privy Council”.
	( ) In subsection (7) of that section—
	(a) for “Secretary of State” substitute “Privy Council”, and
	(b) in paragraph (a), omit “he or”.’.
	Amendment 243,page212,line30, at end insert—
	‘(7A) In section 38 of that Act (regulations and orders), in subsection (2), omit “27”.
	(7B) In subsection (3) of that section, for “the Secretary of State” substitute “the Privy Council”.
	(7C) After subsection (3D) of that section (inserted by section 227(3)) insert—
	“(3E) A statutory instrument containing regulations made by the Privy Council under section 27 is subject to annulment in pursuance of a resolution of either House of Parliament.”.’.—(Mr Lansley.)

Clause 227
	 — 
	Funding of the Authority

Amendment made: 244,page214,line12, leave out from ‘Parliament’ to end of line 17 and insert—
	“(3B) Regulations made by the Privy Council under section 25A that include provision which would, if included in an Act of the Scottish Parliament, fall within the legislative competence of that Parliament shall be subject to the negative procedure in that Parliament (in addition to the statutory instrument containing the regulations being subject to annulment under subsection (3A)).
	(3C) Sections 28 and 31 of the Interpretation and Legislative Reform (Scotland) Act 2010 (negative procedure etc.) shall apply in relation to regulations of the description given in subsection (3B) as they apply in relation to devolved subordinate legislation (within the meaning of Part 2 of that Act) that is subject to the negative procedure, but as if references to a Scottish statutory instrument were references to a statutory instrument.
	(3D) Section 32 of that Act (laying) shall apply in relation to the laying of a statutory instrument containing regulations of the description given in subsection (3B) before the Scottish Parliament as it applies in relation to the laying of a Scottish statutory instrument (within the meaning of Part 2 of that Act) before that Parliament.”’.—(Mr Lansley.)

Clause 229
	 — 
	Accountability and governance

Amendment made: 245,page215,line43, leave out ‘(3A) (inserted by section227(3))’ and insert ‘(3E) (inserted by section226(7C))’.—(Mr Lansley.)

Clause 230
	 — 
	Appointments to regulatory bodies

Amendments made: 246,page216,line11, leave out ‘its appointment power’ and insert ‘any of its appointment functions’.
	Amendment 247,page216,line15, leave out ‘its appointment power’ and insert ‘any of its appointment functions’.
	Amendment 248,page216,line17, leave out ‘power’ and insert ‘function’.
	Amendment 249,page216,line20, leave out ‘its appointment power’ and insert ‘any of its appointment functions’.
	Amendment 250,page216,line22, leave out ‘power’ and insert ‘function’.
	Amendment 251,page216,line25, leave out ‘power’ and insert ‘function’.
	Amendment 252,page216,line27, leave out ‘power’ and insert ‘function’.
	Amendment 253,page216,line31, leave out ‘power’ and insert ‘function’.
	Amendment 254,page216,line35, leave out subsection (8) and insert—
	‘(8) In this section, “appointment functions” means—
	(a) in relation to the General Medical Council, the function under paragraph 1A(2) of Schedule 1 to the Medical Act 1983 and such functions as the Privy Council from time to time has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (appointment of members and chair and determination of terms of office),
	(b) in relation to the General Dental Council, the function under paragraph 1A(2) of Schedule 1 to the Dentists Act 1984 and such functions as the Privy Council from time to time has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council),
	(c) in relation to the General Optical Council, the function under paragraph 1A(2) of Schedule 1 to the Opticians Act 1989 and such functions as the Privy Council from time to time has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council),
	(d) in relation to the General Osteopathic Council, the function under paragraph 1A(2) of the Schedule to the Osteopaths Act 1993 and such functions as the
	Privy Council from time to time has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council),
	(e) in relation to the General Chiropractic Council, the function under paragraph 1A(2) of Schedule 1 to the Chiropractors Act 1994 and such functions as the Privy Council has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council),
	(f) in relation to the General Pharmaceutical Council, the function under paragraph 1(2) of Schedule 1 to the Pharmacy Order 2010 (S.I. 2010/231) and such functions as the Privy Council from time to time has by virtue of paragraph 2(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council),
	(g) in relation to the Nursing and Midwifery Council, the function under paragraph 1A(2) of Schedule 1 to the Nursing and Midwifery Order 2001 (S.I. 2002/253) and such functions as the Privy Council from time to time has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council), and
	(h) in relation to the Health and Care Professions Council, the function under paragraph 1(2) of Schedule 1 to the Health and Social Work Professions Order 2001 (S.I. 2002/254) and such functions as the Privy Council from time to time has by virtue of paragraph 1B(1)(b) or (d) of that Schedule (corresponding functions in relation to that Council).’.
	Amendment 255,page217,line13, leave out ‘power’ and insert ‘function’.
	Amendment 256,page217,line14, leave out ‘power’ and insert ‘function’.—(Mr Lansley.)

Clause 233
	 — 
	Consequential provisions and savings, etc.

Amendment made: 257,page223,line25, after ‘25A’ insert ‘, 27’.—(Mr Lansley.)

Clause 237
	 — 
	Quality standards

Amendments made: 258,page225,line2, leave out ‘must be’ and insert
	‘has no effect unless it is’.
	Amendment 259,page225,line6, leave out ‘generally or’ and insert ‘or to disseminate it’.
	Amendment 260,page225,line33, leave out ‘or 12’.—(Mr Lansley.)

Clause 244
	 — 
	Commissioning guidance

Amendment made: 261,page229,line18, after ‘guidance’, insert ‘to such persons and’.—(Mr Lansley.)

Clause 253
	 — 
	Powers to publish information standards

Amendments made: 262,page232,line38, leave out ‘to which the information standard relates’.
	Amendment 263,page232,line42, leave out ‘, to which the information standard relates’.
	Amendment 264,page233,line21, leave out ‘or 12’.—(Mr Lansley.)

Clause 257
	 — 
	Powers to direct Information Centre to establish information systems

Amendments made: 265,page234,line30, leave out
	‘, analysis and publication or other dissemination’
	and insert ‘and analysis’.
	Amendment 266,page235,line4, leave out ‘or 12’.
	Amendment 267,page235,line11, leave out subsection (7).—(Mr Lansley.)

Clause 258
	 — 
	Powers to request Information Centre to establish information systems

Amendments made: 268,page235,line17, leave out
	‘, analysis and publication or other dissemination’
	and insert ‘and analysis’.
	Amendment 269,page235,line24, leave out subsection (3).
	Amendment 270,page235,line43, leave out ‘the United Kingdom’ and insert ‘England’.—(Mr Lansley.)

Clause 262
	 — 
	Publication of information

Amendments made: 271,page238,line19, at end insert
	‘which is collected pursuant to the direction’.
	Amendment 272,page238,line20, leave out subsections (4) to (7).
	Amendment 273,page238,line42, leave out from ‘258’ to end of line 44 and insert
	‘, the Centre—
	(a) must comply with the requirements (if any) specified in the direction or mandatory request as to the form, manner and timing of publication of the information, and
	(b) may publish the information in such other form and such other manner, and at such other times, as it considers appropriate.’.
	Amendment 274,page238,line47, leave out from ‘Centre’ to end of line 48 and insert ‘—
	(a) may act in accordance with such provision (if any) as may be included in the request as to the form, manner and timing of publication of the information, and
	(b) may publish the information in such other form and such other manner, and at such other times, as it considers appropriate.’.
	Amendment 275,page239,line1, leave out ‘intervals for’ and insert ‘timings of’.
	Amendment 276,page239,line7, leave out ‘section’ and insert ‘Chapter’.—(Mr Lansley.)

Clause 274
	 — 
	Interpretation of this Chapter

Amendments made: 277,page243,line28, leave out paragraph (c) and insert—
	‘(c) a Northern Ireland Minister;’.
	Amendment 278,page243,line35, at end insert—
	‘“Northern Ireland Minister” includes the First Minister, the deputy First Minister and a Northern Ireland Department;’.
	Amendment 279,page243,line40, at end insert—
	‘“relevant person” has the meaning given by section 262.’.—(Mr Lansley.)

Clause 299
	 — 
	Transfer schemes

Amendments made: 280,page257,line14, leave out ‘section 300’ and insert ‘sections300 and [Subsequent property transfer schemes]’.
	Amendment 281,page257,line18, at end insert ‘or the Board’.—(Mr Lansley.)

Clause 302
	 — 
	Regulations, orders and directions

Amendments made: 282,page259,line39, leave out from ‘section’ to end of line 40 and insert
	‘[Duration of transitional period] (extension of transitional period during which licence conditions may be imposed on NHS foundation trusts)’.
	Amendment 283,page260,line11, leave out subsection (6) and insert—
	‘(6) An order by the Privy Council under this Act that includes provision which would, if included in an Act of the Scottish Parliament, fall within the legislative competence of that Parliament is subject to the negative procedure in that Parliament (in addition to the statutory instrument containing the order being subject to annulment under subsection (3)).
	(6A) Sections 28 and 31 of the Interpretation and Legislative Reform (Scotland) Act 2010 (negative procedure etc.) apply in relation to an order of the description given in subsection (6) as they apply in relation to devolved subordinate legislation (within the meaning of Part 2 of that Act) that is subject to the negative procedure, but as if references to a Scottish statutory instrument were references to a statutory instrument.
	(6B) Section 32 of that Act (laying) shall apply in relation to the laying of a statutory instrument containing an order of the description given in subsection (6) before the Scottish Parliament as it applies in relation to the laying of a Scottish statutory instrument (within the meaning of Part 2 of that Act) before that Parliament.’.
	Amendment 284,page260,line37, leave out ‘or transitional’ and insert ‘, transitional or transitory’.
	Amendment 285,page260,line42, at end insert—
	‘(8A) If a draft of a statutory instrument containing an order under section [Duration of transitional period] would, but for this subsection, be treated for the purposes of the Standing Orders of either House of Parliament as a hybrid instrument, it is to proceed in that House as if it were not a hybrid instrument.’.
	Amendment 286,page260,line45, leave out ‘must be given by regulations or’ and insert
	‘—
	(a) must, in the case of a direction under any of the following provisions, be given by regulations or an instrument in writing—
	(i) section 66(2) (direction to Monitor to perform functions);
	(ii) section 237(1) (direction to NICE to prepare quality standards);
	(iii) section 248(1) (direction to NICE to perform functions);
	(iv) section 252(8) (direction to Board to be transitional commissioner in relation to pre-commencement statements of quality standards);
	(v) section 257(1) (direction to Information Centre to establish information systems);
	(vi) section 258(6) or (7) (direction to Information Centre to comply, or not to comply, with request to establish information systems);
	(vii) section 262(2)(d) (direction to Information Centre that information of specified description is not subject to duty to publish);
	(viii) section 271(1) (direction to Information Centre to perform functions);
	(ix) paragraph 4 of Schedule6 (direction to Board to exercise functions of Secretary of State relating to Primary Care Trusts), and
	(b) must, in the case of any other direction, be given by’.—(Mr Lansley.)

Clause 304
	 — 
	Commencement

Amendment made: 287,page261,line29, leave out from beginning to ‘may’ in line 30 and insert
	‘Transitory provision in an order under subsection (2) or (4)’.—(Mr Lansley.)

Clause 305
	 — 
	Extent

Amendments made: 288,page261,line43, at end insert—
	‘() section42 insofar as it inserts section 252A(7A) of the National Health Service Act 2006;’.
	Amendment 289,page262,line16, leave out subsection (4).
	Amendment 290,page262,line18, leave out ‘The following provisions’ and insert
	‘Sections 131 to 136 (health special administration)’.
	Amendment 291,page262,line19, leave out paragraphs (a) and (b).—(Mr Lansley.)

Schedule 2
	 — 
	Commissioning consortia

Amendments made: 292,page270, leave out lines 21 to 23.
	Amendment 293,page270,line30, at end insert—
	‘( ) In this paragraph, references to the functions of the governing body of a clinical commissioning group include references to the functions of the clinical commissioning group which are exercisable by the governing body under arrangements specified in the constitution by virtue of paragraph 3(3).’.
	Amendment 294,page271,line18, leave out from ‘employees’ to ‘under’ in line 19 and insert
	‘remuneration and travelling or other allowances in accordance with determinations made by its governing body’.
	Amendment 295,page272,line13, leave out from ‘pay’ to end of line 14 and insert
	‘remuneration and travelling or other allowances to the accountable officer in accordance with determinations made by its governing body under section 14L(3)(a)’.
	Amendment 296,page272,line14, at end insert—
	‘(5A) A clinical commissioning group may, for or in respect of its accountable officer, make arrangements for providing pensions, allowances or gratuities.
	(5B) The arrangements that may be made under sub-paragraph (5A) include arrangements for the provision of pensions, allowances or gratuities by way of compensation to or in respect of the accountable officer where the officer suffers loss of office or loss or diminution of emoluments.
	(5C) Where a clinical commissioning group has, by virtue of paragraph 10(4), established a pension scheme, the arrangements that may be made under sub-paragraph (5A) include arrangements for the accountable officer to be a member of the scheme.’.
	Amendment 297,page272,line26, at end insert—
	‘Remuneration etc for members of governing bodies
	(1) A clinical commissioning group may pay members of its governing body such remuneration and travelling or other allowances as it considers appropriate.
	(2) A clinical commissioning group may, for or in respect of such members of its governing body as it may determine, make arrangements for providing pensions, allowances or gratuities.
	(3) Such arrangements may include the establishment and administration, by the clinical commissioning group or otherwise, of one or more pension schemes.
	(4) The arrangements that may be made under sub-paragraph (2) include arrangements for the provision of pensions, allowances or gratuities by way of compensation to or in respect of any members of the governing body who suffer loss or diminution of emoluments.
	(5) Where a clinical commissioning group has, by virtue of paragraph 10(4), established a pension scheme, the arrangements that may be made under sub-paragraph (2) include arrangements for members of the governing body to be members of the scheme.
	(6) Sub-paragraph (2) does not apply to members of the governing body who are—
	(a) members or employees of the clinical commissioning group, or
	(b) members or employees of a body that is a member of the clinical commissioning group.’.
	Amendment 298,page272,line26, at end insert—
	‘Additional powers in respect of payment of allowances
	A clinical commissioning group may pay such travel or other allowances as it considers appropriate to any of the following—
	(a) members of the clinical commissioning group who are individuals;
	(b) individuals authorised to act on behalf of a member of the clinical commissioning group in dealings between the member and the group;
	(c) members of any committee or sub-committee of the clinical commissioning group or its governing body.’.
	Amendment 299,page274, leave out lines 14 to 16.—(Mr Lansley.)

Schedule 4
	 — 
	Amendments of the National Health Service Act 2006

Amendments made: 300,page279,line33, after ‘(4)’ insert ‘—
	( ) after paragraph (a) insert—
	“(aa) the Board,
	(ab) a clinical commissioning group,
	(ac) a local authority,”,’.
	Amendment 301,page279,line35, at end insert—
	‘( ) After subsection (4) insert—
	(4A) In subsection (4), “local authority” has the same meaning as in section 2B.”’.
	Amendment 302,page280,line37, leave out ‘or a commissioning consortium’ and insert ‘, a clinical commissioning group or a local authority’.
	Amendment 303,page280,line41, after ‘State’, insert ‘or a local authority’.
	Amendment 304,page281,line7, at end insert—
	‘( ) After subsection (6) insert—
	(7) In this section and sections 12B to 12D, “local authority” has the same meaning as in section 2B.”’.
	Amendment 305,page281,line10, leave out ‘or a commissioning consortium’ and insert
	‘, a clinical commissioning group or a local authority’.
	Amendment 306,page281,line13, leave out ‘or a commissioning consortium’ and insert
	‘, a clinical commissioning group or a local authority’.
	Amendment 307,page281,line15, leave out ‘or the commissioning consortium’ and insert
	‘, clinical commissioning group or local authority’.
	Amendment 308,page281,line18, leave out ‘or’ and insert
	‘or a local authority or as’.
	Amendment 309,page281,line22, leave out ‘or a commissioning consortium’ and insert
	‘, a clinical commissioning group or a local authority’.
	Amendment 310,page281,line29, leave out ‘or a commissioning consortium’ and insert
	‘, a clinical commissioning group or a local authority’.
	Amendment 311,page281,line31, leave out ‘or a commissioning consortium’ and insert
	‘, a clinical commissioning group or a local authority’.
	Amendment 312,page281,line35, at end insert—
	In section 29 (exercise of Special Health Authority functions), in subsection (2)(a)—
	(a) omit “, section 14”, and
	(b) omit “, section 19”.’.
	Amendment 313,page282,line14, at end insert —
	( ) after paragraph (h) (and before the “and” immediately following it) insert—
	“(ha) a company formed under section 223 and wholly or partly owned by the Secretary of State or the Board,”, and’.
	Amendment 314,page282,line15, leave out from ‘(i)’ to end of line 16 and insert ‘—
	(i) for “paragraphs (a) to (h)”, in the first place where it occurs, substitute “paragraphs (za) to (ha)”, and
	(ii) for “paragraphs (a) to (h)”, in the second place where it occurs, substitute “paragraphs (za) to (h)”.’.
	Amendment 315,page282,line17, after ‘(2A)’, insert ‘—
	( ) after paragraph (a) insert—
	“(ab) in relation to a company within paragraph (ha) of subsection (2), means the company’s activities in providing facilities or services to any person or body;”, and’.
	Amendment 316,page282,line32, leave out ‘In Schedule 4,’ and insert—
	‘(1) Schedule 4 (NHS trusts) is amended as follows.
	(2) In paragraph (5)(1)(f), omit “Primary Care Trusts,”.
	(3) In paragraph 6—
	(a) in sub-paragraph (1) —
	(i) omit “Strategic Health Authority,” and
	(ii) omit “, Primary Care Trust”, and
	(b) in sub-paragraph (2) —
	(i) omit “Strategic Health Authority,” and
	(ii) omit “, Primary Care Trust”.
	(4) In paragraph 7(3), omit “Strategic Health Authority,”.
	(5) In paragraph 8—
	(a) in sub-paragraph (1), omit “, Primary Care Trust” (in each place where it occurs), and
	(b) in sub-paragraph (4), omit “, Primary Care Trust”,
	(c) in sub-paragraph (5), omit “, Primary Care Trust” (in each place where it occurs),
	(d) in sub-paragraph (6)(b), omit “, Primary Care Trust”, and
	(e) in sub-paragraph (9)(b), omit “, Primary Care Trust”.
	(6) In paragraph 9—
	(a) in sub-paragraph (1)—
	(i) omit “a Strategic Health Authority,”, and
	(ii) omit “a Primary Care Trust,”,
	(b) in sub-paragraph (3)—
	(i) omit “Strategic Health Authority,”, and
	(ii) omit “Primary Care Trust,”,
	(c) in sub-paragraph (6)—
	(i) omit “a Strategic Health Authority,”, and
	(ii) omit “, a Primary Care Trust,”,
	(d) in sub-paragraph (7)—
	(i) in paragraph (a), omit “Strategic Health Authority,”,
	(ii) in that paragraph omit “or belong to a Primary Care Trust”, and
	(iii) in the words following paragraph (b)—omit “Strategic Health Authority,”, and omit “Primary Care Trust,”.’.
	Amendment 317,page282,line32, at end insert—
	‘( ) In paragraph 18—
	(a) omit “Strategic Health Authority,” and
	(b) omit “Primary Care Trust,”.
	( ) In paragraph 29, in sub-paragraph (3) omit “Strategic Health Authority,”.
	( ) In paragraph 30, in sub-paragraph (1)—
	(a) omit “Strategic Health Authority,” and
	(b) omit “Primary Care Trust,”.’.
	Amendment 318,page283,line34, at end insert
	‘(including by virtue of section 7A)’.
	Amendment 319,page284,line37, at end insert—
	‘( ) The reference in subsection (9) to arrangements made by the Board or (as the case may be) a clinical commissioning group include references to arrangements so made by virtue of section 7A.”’.
	Amendment 320,page296,line16, after ‘(4A)(a)’ insert ‘—
	(a) ’.
	Amendment 321,page296,line16, after ‘Board”’ insert ‘, and
	(b) for “to persons who provide” substitute “for providing”.’.
	Amendment 322,page302,line21, leave out paragraph (c) and insert—
	‘(c) for paragraph (d) substitute —
	“(d) in any other case—
	(i) where the hospital is vested in the Secretary of State, the Special Health Authority exercising functions of the Secretary of State in respect of it or, where there is no such Special Health Authority, the Secretary of State,
	(ii) where the Welsh Ministers have functions in respect of the hospital, the Special Health Authority or Local Health Board exercising those functions.”’.
	Amendment 323,page303,line42, at end insert
	‘or pursuant to arrangements made in the exercise (by any person) of the public health functions of the Secretary of State or a local authority.”’.
	Amendment 324,page305,line32, at end insert—
	In section 271 (territorial limit of exercise of functions), in the words in brackets in subsection (3)(a), after “directions to” insert “certain”.’.
	Amendment 325,page305,line32, at end insert—
	After section 271 insert—
	“271A Services to be treated as services of the Crown for certain purposes
	(1) Services to which this section applies are to be treated as services of the Crown for the purposes of—
	(a) Schedule 1 to the Registered Designs Act 1949 (provisions as to the use of registered designs for the services of the Crown etc.), and
	(b) sections 55 to 59 of the Patents Act 1977 (use of patented inventions for the services of the Crown).
	(2) This section applies to services provided in pursuance of—
	(a) the functions of the Board or a clinical commissioning group under section 3, 3A, 3B or 4 or Schedule 1, or
	(b) the public health functions of a local authority.”’.
	Amendment 326,page305,line34, after ‘(3)’, insert ‘—
	(a) omit paragraph (b), and’.
	Amendment 327,page305,line40, after ‘(4)(c)(ii)’, insert ‘—
	(a) after “8,” insert “13Z1,”, and’.
	Amendment 328,page306,line21, at end insert—
	‘( ) Until the commencement of section 29, the definition of “NHS body” in section 275 of the National Health Service Act 2006 has effect as if it included a reference to a Strategic Health Authority.’.—(Mr Lansley.)

Schedule 5
	 — 
	Part 1: amendments and other enactments

Amendments made: 329,page310,line5, at end insert ‘the Secretary of State,’.
	Amendment 330,page310,line15, after ‘(2)’, insert
	‘(as substituted by the National Health Service Reorganisation Act 1973)’.
	Amendment 331,page310,line45, at end insert—
	‘Local Government Act 1974 (c.7)
	In section 26 of the Local Government Act 1974 (matters subject to investigation by Local Commissioner), in subsection (1), after paragraph (c) insert—
	“(d) an alleged or apparent failure in a service provided by the authority in pursuance of arrangements under section 7A of the National Health Service Act 2006;
	(e) an alleged or apparent failure to provide a service in pursuance of such arrangements.”’.
	Amendment 332,page312,line37, at end insert—after “the National Health Service (Wales) Act 2006,” (in the second place where it occurs) insert
	“the Secretary of State where the Secretary is responsible for the administration of the hospital or”,’.
	Amendment 333,page313,line11, leave out from ‘(2)(aa)’ to end of line 13 and insert ‘—
	(a) omit “under section 92 of the National Health Service Act 2006 or”,
	(b) after “section 100” insert “of the National Health Service Act 2006 or an agreement under section 107”,
	(c) omit “under section 50 of the National Health Service (Wales) Act 2006 or”, and
	(d) after “section 57” insert “of the National Health Service (Wales) Act 2006 or an agreement under section 64”.’.
	Amendment 334,page315,line3, after ‘insert “’, insert ‘the Secretary of State,’.
	Amendment 335,page315,line11, after ‘by’, insert ‘the Secretary of State,’.
	Amendment 336,page315,line18, after ‘by’, insert ‘the Secretary of State,’.
	Amendment 337,page315,line32, after ‘insert “’, insert ‘the Secretary of State,’.
	Amendment 338,page315,line47, after ‘by’, insert ‘the Secretary of State,’.
	Amendment 339,page316,line6, after ‘by’, insert ‘the Secretary of State,’.
	Amendment 340,page316,line16, after ‘by’, insert ‘the Secretary of State,’.
	Amendment 341,page316,line20, after ‘to’, insert ‘the Secretary of State,’.
	Amendment 342,page316,line29, at end insert—
	‘( ) After subsection (7) insert—
	(7A) References in this Act to a hospital or accommodation made available or provided pursuant to arrangements made by the Secretary of State under the National Health Service Act 2006 are references to a hospital or accommodation made available or provided pursuant to arrangements so made in the exercise of the public health functions of the Secretary of State (within the meaning of that Act).
	(7B) References in this Act to arrangements made by the National Health Service Commissioning Board or a clinical commissioning group under the National Health Service Act 2006 include references to arrangements so made by virtue of section 7A of that Act.”’.
	Amendment 343,page316,line40, after ‘services’, insert
	‘(including services that may be provided pursuant to such arrangements by virtue of section 7A of that Act)’.
	Amendment 344,page317,line31, leave out from ‘substitute’ to end of line 33 and insert
	‘“by any person in pursuance of arrangements made by the National Health Service Commissioning Board or by a clinical commissioning group under the National Health Service Act 2006 (including by virtue of section 7A of that Act)”.’.
	Amendment 345,page318,line22, at end insert—
	The Health Service Commissioners Act 1993 is amended as follows.In section 2 (health service bodies subject to investigation), in subsection (1)—
	(a) omit paragraph (a),
	(b) omit paragraph (da), and
	(c) after paragraph (db) insert—
	“(dc) the National Health Service Commissioning Board,
	(dd) clinical commissioning groups.”’.
	In section 2A (health service providers subject to investigation), in subsection (1)(a) for “a Primary Care Trust” substitute “the National Health Service Commissioning Board”.
	(1) Section 14 (reports etc. by the Commissioner) is amended as follows.
	(2) In subsection (1)—
	(a) at the end of paragraph (c) insert “and”, and
	(b) omit paragraph (e) and the preceding “and”.
	(3) In subsection (2A)—
	(a) at the end of paragraph (d) insert “and”, and
	(b) omit paragraph (f) and the preceding “and”.
	(4) In subsection (2C)—
	(a) at the end of paragraph (d) insert “and”, and
	(b) omit paragraph (f) and the preceding “and”.
	(5) Omit subsection (2E)(e).
	(6) In subsection (2G)—
	(a) at the end of paragraph (c) insert “and”, and
	(b) omit paragraph (e) and the preceding “and”.’.
	Amendment 346,page318,line23, leave out
	‘of the Health Service Commissioners Act 1993’.
	Amendment 347,page322,line36, at end insert—
	‘Regulation of Investigatory Powers Act 2000 (c.23)
	In section 4 of the Regulation of Investigatory Powers Act 2000 (power to provide for lawful interception) in subsection (5) for “section 8 of the National Health Service Act 2006” substitute “section 4(3A)(a) of the National Health Service Act 2006”.’.
	Amendment 348,page323,line29, after ‘2006’, insert
	‘(including by virtue of section 7A of that Act)’.
	Amendment 349,page325,line16, at end insert—
	In section 113 (complaints about health care), in subsection (1), after paragraph (c) insert—
	“(d) anything done by the National Health Service Commissioning Board or a clinical commissioning group in pursuance of arrangements made under section 7A of the National Health Service Act 2006.”’.
	Amendment 350,page326,line17, at end insert—
	‘“() the Secretary of State, in relation to the exercise of functions under section 2A or 2B of, or paragraph 7C, 8 or 12 of Schedule 1 to, the National Health Service Act 2006,’.
	Amendment 351,page327,line18, at end insert—
	‘Civil Contingencies Act 2004 (c.36)
	(1) Schedule 1 to the Civil Contingencies Act 2004 (lists of Category 1 and 2 responders) is amended as follows.
	(2) In Part 1 (which contains the general list of Category 1 responders)—
	(a) after the cross-heading “Health” insert—
	4A The National Health Service Commissioning Board.”, and
	(b) omit paragraph 7.
	(3) In Part 3 (which contains the general list of Category 2 responders)—
	(a) after the cross-heading “Health” insert—
	29ZA A clinical commissioning group established under section 14D of the National Health Service Act 2006.”, and
	(b) omit paragraph 29A.’.
	Amendment 352,page327,line45, leave out ‘and’ and insert—
	( ) after that paragraph insert—
	(aa) in relation to England, if the hospital falls within paragraph (a)(i) or (ii) and no Special Health Authority has responsibility for its administration, the Secretary of State;”,’.
	Amendment 353,page331,line9, after ‘networks)’ insert ‘—
	(a) for “services-provider”, in each place it appears, substitute “responsible person”,
	(b) in subsection (2), before paragraph (a) insert—
	“(za) the National Health Service Commissioning Board;
	(zb) a clinical commissioning group;”,
	(c) ’.
	Amendment 354,page331,line9, at end insert ‘, and
	() in the title, for “services-providers” substitute “responsible persons”.
	Amendment 355,page333,line24, leave out ‘or 12’.
	Amendment 356,page335,line45, at end insert—
	In section 36 (disclosure of information by Her Majesty’s Revenue and Customs), in subsection (3) after paragraph (a) insert—
	“(aa) the National Health Service Commissioning Board;”.’.—(Mr Lansley.)

Schedule 6
	 — 
	Part 1: transitional provision

Amendments made: 357,page336,line36, at end insert—
	‘Modification of requirements as to consultation
	(1) If, at any time before the commencement of section 6, the Secretary of State consults a Special Health Authority as to the making of regulations under section 3B of the 2006 Act (as inserted by section 12), the consultation is to be treated for the purposes of subsection (4)(b) of section 3B as consultation with the Board.
	(2) If, at any time before the commencement of section 6, the Secretary of State consults a Special Health Authority about the objectives or requirements to be included in the first mandate published under section 13A of the 2006 Act (as inserted by section 20), the consultation is to be treated for the purposes of subsection (8)(a) of section 13A as consultation with the Board.’.
	Amendment 358,page336,line37, at end insert—
	1A (1) This paragraph applies if section 18 is commenced before section 29(1).
	(2) Until section 29(1) is commenced, section 7(1) of the 2006 Act has effect as if after “Special Health Authority” there were inserted “or Strategic Health Authority”.
	(3) Sub-paragraph (4) applies in relation to any direction given under section 7(1) of the 2006 Act to a Strategic Health Authority which has effect immediately before section 18 is commenced.
	(4) Until section 29(1) is commenced, the direction continues to have effect as if given to the Strategic Health Authority under section 7(1) of the 2006 Act (as it has effect by virtue of sub-paragraph (2)).
	(5) Sub-paragraph (6) applies in relation to any direction given under section 7(2) of the 2006 Act to a Special Health Authority in respect of the functions of a Strategic Health Authority which has effect immediately before section 18 is commenced.
	(6) Until section 29(1) is commenced, the direction continues to have effect as if given to the Special Health Authority in respect of the functions of the Strategic Health Authority under section 7(1) of the 2006 Act.
	(7) Any reference in this paragraph to section 7(1) of the 2006 Act is a reference to that provision as amended by section 18.’.
	Amendment 359,page337,line24, at end insert—
	Any reference in paragraphs 1A to 3 to the commencement of section 18 is to its commencement by virtue of an order under section304(4) (and not to its commencement for limited purposes by virtue of section 304(1)(d)).’.
	Amendment 360,page337,line28, after “Trusts”, insert “or Strategic Health Authorities’.
	Amendment 361,page339,line14, at end insert—
	‘( ) Any reference (however expressed) in the following provisions of Chapter A2 of Part 2 of the National Health Service Act 2006 to the functions of a clinical commissioning group includes a reference to the functions of a Primary Care Trust that are exercisable by the group by virtue of sub-paragraph (1)—
	(a) section 14O(1),
	(b) section 14P,
	(c) section 14Q(1),
	(d) section 14S(1),
	(e) section 14T(1),
	(f) section 14U(1),
	(g) section 14V(1),
	(h) section 14W(1),
	(i) section 14X,
	(j) section 14Y(1) and (2),
	(k) section 14Z1(7).
	(l) section 14Z2(1),
	(m) section 14Z3(2),
	(n) section 14Z5(7) insofar as it defines “commissioning functions” in section 14Z6,
	(o) sections 14Z15(1), 14Z17(1) and 14Z19(1) and (3),
	(p) in Schedule 1A, paragraphs 3(1) and (3), 5 and 11(6)(b).’.
	Amendment 362,page339,line14, at end insert—
	‘( ) Arrangements made under sub-paragraph (1) do not affect the liability of the Primary Care Trust for the exercise of any of its functions.’.
	Amendment 363,page339,line14, at end insert—
	‘Power to make payments to the Board during initial period
	(1) The Secretary of State may make payments to the Board of such amounts as the Secretary of State considers appropriate towards meeting the expenditure of the Board which is attributable to the performance by it of its functions during the initial period.
	(2) Payments under sub-paragraph (1) may be made at such times and on such terms and conditions as the Secretary of State considers appropriate.’.
	Amendment 364,page339,line14, at end insert—
	‘Support for clinical commissioning groups during initial period
	(1) A Primary Care Trust may provide assistance or support to a clinical commissioning group during the initial period.
	(2) The assistance that may be provided includes—
	(a) financial assistance, and
	(b) making the services of the Trust’s employees or any other resources of the Trust available to the group.
	(3) Assistance or support provided under this paragraph may be provided on such terms and conditions, including terms as to payment, as the Trust considers appropriate.
	(4) The Primary Care Trust may, in particular, impose restrictions on the use of any financial or other assistance or support provided under this paragraph.
	(5) A clinical commissioning group must comply with any restrictions imposed under sub-paragraph (4).’.—(Mr Lansley.)

Schedule 7
	 — 
	Abolition of the Health Protection Agency: consequential amendments

Amendment made: 365,page341,line8, at end insert—
	‘Civil Contingencies Act 2004 (c.36)
	In Schedule 1 to the Civil Contingencies Act 2004, in Part 1 (list of Category 1 responders) for paragraph 9 substitute—9 The Secretary of State, in so far as the functions of the Secretary of State include responding to emergencies by virtue of —
	(a) the Secretary of State’s functions under section 2A of the National Health Service Act 2006,
	(b) the Secretary of State’s functions under section 54 of the Health and Social Care Act 2011 in so far as it applies in relation to Wales or Scotland, or
	(c) arrangements made by the Welsh Ministers or Scottish Ministers under which the Secretary of State exercises on their behalf functions in relation to protecting the public in Wales or Scotland from disease or other dangers to health.”’.—(Mr Lansley.)

Schedule 15
	 — 
	Local Healthwatch Organisations

Amendment made: 373,page378,line21, at end insert—
	‘(5) The regulations may impose duties on a responsible person as respects responding to requests for information made by a person who has power to appoint a member of an LHW when discharging the duty imposed by virtue of sub-paragraph (3).
	(6) In sub-paragraph (5), “responsible person” means a responsible person for the purposes of section 224(1).’.—(Mr Lansley.)

Schedule 16
	 — 
	Part 7: consquential amendments and savings

Amendments made: 374,page381,line25, at end insert—
	Omit section 70 (abolition of the Central Council for Education and Training in Social Work).’.
	Amendment 375,page381,line28, at end insert—
	In section 114 (schemes for the transfer of staff), in subsection (1), omit “, 70”.In section 118 (orders and regulations), in subsection (4), omit the words from “; and” to the end.In section 121 (interpretation), in the table in subsection (13), omit the entry for “CCETSW”.In section 122 (commencement), omit “section 70(2) to (5) and”.In section 123 (extent), omit subsection (3).’.
	Amendment 376,page384,line41, at end insert—
	In section 171(4) (provisions which Welsh Ministers have power to commence), before paragraph (a) insert—
	“(za) sections 124 and 125 and Schedule 9 (regulation of social care workers: Wales) and section 126 (education and training of approved mental health professionals: Wales),’.
	Amendment 377,page386,line39, leave out paragraph 53.
	Amendment 378,page388,line7, at end insert—
	Omit section 26(12) of that Act.’.
	Amendment 379,page388,line33, leave out paragraph (e).—(Mr Lansley.)

Schedule 18
	 — 
	Part 8: consequential amendments

Amendments made: 380,page397,line5, at beginning insert—
	‘(1) The Employment Rights Act 1996 is amended as follows.
	(2) In section 50 (right to time off for public duties) in subsection (8), after paragraph (ab) insert—
	“(ac) the National Institute for Health and Care Excellence,”.’.
	Amendment 381,page397,line5, leave out
	‘of the Employment Rights Act 1996’.
	Amendment 382,page397,line7, at end insert—
	‘Data Protection Act 1998 (c.29)
	In section 69 of the Data Protection Act 1998 (meaning of “health professional”) in subsection (3), after paragraph (fa) insert—
	“(fb) the National Institute for Health and Care Excellence,”.’.—(Mr Lansley.)

Schedule 20
	 — 
	Part 9: consequential amendments

Amendments made: 383,page404,line5, at end insert—
	‘Access to Health Records Act 1990 (c.23)
	In section 11 of the Access to Health Records Act 1990 (interpretation) in the definition of “health service body”, at the end insert—
	“(f) the Health and Social Care Information Centre;”.’.
	Amendment 384,page404,line7, at beginning insert—
	‘(1) The Employment Rights Act 1996 is amended as follows.
	(2) In section 50 (right to time off for public duties) in subsection (8), after paragraph (ac) (inserted by Schedule 18) insert—
	“(ad) the Health and Social Care Information Centre,”.’.
	Amendment 385,page404,line7, leave out
	‘of the Employment Rights Act 1996’.
	Amendment 386,page404,line9, at end insert—
	‘Data Protection Act 1998 (c.29)
	In section 69 of the Data Protection Act 1998 (meaning of “health professional”) in subsection (3), after paragraph (fb) (inserted by Schedule 18) insert—
	“(fc) the Health and Social Care Information Centre,”.’.—(Mr Lansley.)

Schedule 22
	 — 
	Amendments relating to relationships between the health services

Amendments made: 387,page409,line2, leave out
	‘the Secretary of State or a body’
	and insert ‘a person’.
	Amendment 388,page409,line3, after ‘(jb),’, insert ‘(m),’.
	Amendment 389,page409,line14, leave out
	‘the Welsh Ministers are, or a body’
	and insert ‘a person’.
	Amendment 390,page409,line15, leave out ‘or (k) is,’ and insert ‘(k) or (ma) is’.
	Amendment 391,page409,line28, after ‘jointly.’, insert—
	“(15) Subsection (16) applies (and subsections (12) and (14) do not apply) where a cross-border Special Health Authority is a party or prospective party to an arrangement or proposed arrangement which—
	(a) falls within subsection (1); and
	(b) also falls within the definition of NHS contract in section 9 of the National Health Service Act 2006 and the definition of NHS contract in section 7 of the National Health Service (Wales) Act 2006.
	(16) Subsections (4) to (9) shall apply in relation to that arrangement or proposed arrangement (except in so far as it relates to reserved matters within the meaning of the Scotland Act 1998) with the substitution for references to the Secretary of State—
	(a) where the cross-border Special Health Authority is exercising functions in relation to England only, of references to the Secretary of State and the Scottish Ministers acting jointly;
	(b) where the Authority is exercising functions in relation to Wales only, of references to the Welsh Ministers and the Scottish Ministers acting jointly; and
	(c) where the Authority is exercising functions in relation to England and Wales, of references to the Secretary of State and the Welsh Ministers acting concurrently with each other and jointly with the Scottish Ministers.
	(17) In subsections (15) and (16), “cross-border Special Health Authority” means a Special Health Authority which is established under the National Health Service Act 2006 and the National Health Service (Wales) Act 2006 by virtue of—
	(a) paragraph 1(2) of Schedule 2 to the National Health Service (Consequential Provisions) Act 2006, or
	(b) the power under section 28 of the National Health Service Act 2006 and the power under section 22 of the National Health Service (Wales) Act 2006 being exercised together.’.
	Amendment 392,page410,line26, after second ‘arrangement’, insert
	‘(except in so far as it relates to reserved matters within the meaning of the Scotland Act 1998)’.
	Amendment 393,page410,line28, after ‘jointly.’, insert—
	“(3) Subsection (4) applies (and subsection (2) does not apply) where a cross-border Special Health authority is a party or prospective party to an arrangement or proposed arrangement which—
	(a) falls within the definition of NHS contract in section 9(1), and
	(b) also falls within the definition of NHS contract in section 17A of the National Health Service (Scotland) Act 1978 and the definition of NHS contract in section 7(1) of the National Health Service (Wales) Act 2006.
	(4) Subsections (5) to (13) of section 9 apply in relation to that arrangement or proposed arrangement (except in so far as it relates to reserved matters within the meaning of the Scotland Act 1998) with the substitution for references to the Secretary of State—
	(a) where the cross-border Special Health Authority is exercising functions in relation to England only, of references to the Secretary of State and the Scottish Ministers acting jointly; and
	(b) where the Authority is exercising functions in relation to England and Wales, of references to the Secretary of State and the Welsh Ministers acting concurrently with each other and jointly with the Scottish Ministers.
	(5) In subsections (3) and (4), “cross-border Special Health Authority” means a Special Health Authority which is established under the National Health Service Act 2006 and the National Health Service (Wales) Act 2006 by virtue of—
	(a) paragraph 1(2) of Schedule 2 to the National Health Service (Consequential Provisions) Act 2006, or
	(b) the power under section 28 of the National Health Service Act 2006 and the power under section 22 of the National Health Service (Wales) Act 2006 being exercised together.’.
	Amendment 394,page410,line32, at end insert—
	‘( ) Until the commencement of section 29 of this Act, subsection (1) of section 66 of the National Health Service Act 2006 has effect as if it included a reference to Strategic Health Authorities.’.
	Amendment 395,page411,line6, at end insert—
	‘( ) Until the commencement of section 29 of this Act, subsection (1) of section 68 of the National Health Service Act 2006 has effect as if it included a reference to Strategic Health Authorities.’.
	Amendment 396,page411,line40, after ‘Ministers’, insert ‘—
	(a) in so far as the arrangement or proposed arrangement relates to reserved matters within the meaning of the Scotland Act 1998, of references to the Welsh Ministers and the Secretary of State acting jointly, and
	(b) for all other purposes,’.
	Amendment 397,page411,line41, after ‘jointly.’, insert—
	“(3) Subsection (4) applies (and subsection (2) does not apply) where a cross-border Special Health Authority is a party or prospective party to an arrangement or proposed arrangement which—
	(a) falls within the definition of NHS contract in section 7(1), and
	(b) also falls within the definition of NHS contract in section 17A of the National Health Service (Scotland) Act 1978 and the definition of NHS contract in section 9(1) of the National Health Service Act 2006.
	(4) Subsections (5) to (13) of section 7 apply in relation to the arrangement or proposed arrangement (except in so far as it relates to reserved matters within the meaning of the Scotland Act 1998) with the substitution for references to the Welsh Ministers—
	(a) where the cross-border Special Health Authority is exercising functions in relation to Wales only, of references to the Welsh Ministers and the Scottish Ministers acting jointly, and
	(b) where the Authority is exercising functions in relation to England and Wales, of references to the Welsh Ministers and the Secretary of State acting concurrently with each other and jointly with the Scottish Ministers.
	(5) In subsections (3) and (4), “cross-border Special Health Authority” means a Special Health Authority which is established under the National Health Service Act 2006 and the National Health Service (Wales) Act 2006 by virtue of—
	(a) paragraph 1(2) of Schedule 2 to the National Health Service (Consequential Provisions) Act 2006, or
	(b) the power under section 28 of the National Health Service Act 2006 and the power under section 22 of the National Health Service (Wales) Act 2006 being exercised together.’.
	Amendment 398,page413,line7, leave out from ‘services),’ to end of line 10 and insert ‘omit subsection (4)’.
	Amendment 399,page413,line16, leave out from ‘services),’ to end of line 19 and insert ‘omit subsection (4)’.
	Amendment 400,page416,line42, at end insert—
	( ) omit sub-paragraph (i),’.
	Amendment 401,page416,line44 [Schedule 22], leave out ‘after sub-paragraph (i)’ and insert ‘before sub-paragraph (j)’.—(Mr Lansley.)

Schedule 23
	 — 
	Property transfer schemes

Amendment made: 402,page418,line41, column 2, at end insert—
	‘A Special Health Authority
	A qualifying company’.—(Mr Lansley.)
	Third Reading

Andrew Lansley: I beg to move, That the Bill be now read the Third time.
	The national health service is among our most valued and loved institutions. Indeed, it is often described as the closest thing we have to a national religion. I am not sure that that was always intended to be complimentary, but I think it should be. People in this country believe in the NHS wholeheartedly, share in its values and the social solidarity it brings, and admire the doctors, nurses and staff who work in it.
	It is because I share that belief that I am here. Over eight years, I have supported, challenged and defended the NHS. As a party, and now as a Government, we have pledged unwavering support for the NHS, both in principle, because we believe in the values of the NHS, and in a practical way because we are reforming the NHS to secure its future alongside the additional £12.5 billion of taxpayer funding over the next four years that we have pledged for the NHS in England.

Nicola Blackwood: Will my right hon. Friend give way?

Andrew Lansley: If my hon. Friend will forgive me, I will not give way because other Members wish to speak on Third Reading.
	In Wales, a Labour Government are cutting the budget for the NHS. The coalition Government’s commitment to the NHS will not waver. The Government and I, as Health Secretary, will always be accountable for promoting and securing the provision of a comprehensive health service that is free and based on need, not ability to pay.
	What matters to patients is not only how the NHS works, but, more importantly, the improvements that the modernisations will energise—a stronger patient voice, clinical leadership, shared NHS and local government leadership in improving public health, and innovation and enterprise in clinical services. Everyone will benefit from the fruit that the Bill and the reforms bring. There will be improved survival rates, a personalised service tailored to the choices and needs of patients, better access to the right care at the right time, and meaningful information to support decisions. The Bill provides the constitution and structure that the NHS needs to work for the long term.
	Patients know that it is their doctors and nurses—the people in whom they place their trust—who make the best decisions about their individual care. The Bill is about helping those people to become leaders. It is not about turning medical professionals into managers or administrators, but about turning the NHS from a top-down administrative pyramid with managers and administrators at its zenith into a clinically led service that is responsive to patients, with management support on tap, not on top. It is about putting real power into the hands of patients, ensuring that there truly is “no decision about me without me”. My only motivation is to safeguard and strengthen the NHS, and that is why I am convinced that the principles of this modernisation are necessary.
	Of course, the Bill has been through a long passage. There have been questions and new ideas, and many concerns and issues have been raised. We have done throughout, and will continue to do, what all Governments should do—listen, reflect, then respond and improve. The scrutiny process to this point has been detailed and forensic. There were the original 6,000 responses to the White Paper consultation, many public and stakeholder meetings and 28 sittings in Committee, after which the hon. Member for Halton (Derek Twigg) acknowledged that “every inch” of the Bill had been scrutinised, but we were still none the less determined to listen, reflect and improve.
	I wish to thank the NHS Future Forum, under Steve Field’s leadership, for its excellent and continuing work. I also thank more than 8,000 members of the public, health professionals and representatives of more than 250 stakeholder organisations who supported the Future Forum and the listening exercise and attended some 250 events across the country. That forum and those people represented the views of the professionals who will implement and deliver the changes, and we accepted all their core recommendations. We brought the Bill back to Committee—the first such Bill since 2003—and we have continued to listen and respond positively. The Bill is better and stronger as a result.

William Cash: Will my right hon. Friend give way?

Andrew Lansley: No.
	At the heart of the changes is support for clinical leadership, which has always been key in putting health professionals, and not only managers, at the heart of decision making in the NHS. That was why we strengthened the Bill to ensure that all relevant health professionals would be involved in the design and commissioning of services at every level and in the leadership of clinical commissioning groups. They will also be brought together through clinical networks on specific conditions and services, as they often are now, such as in the case of cancer networks. They will be brought together in broad geographic areas, through new clinical senates, to look across services and advise.
	The Bill was strong in transparency and openness from the outset, and that now flows through every aspect of modernisation. Indeed, the Future Forum is taking forward another of our central principles of reform, which is to develop high-quality and integrated services. Properly integrated services are essential for the quality of individual care and for the most efficient operation of the NHS. That was why we proposed health and well-being boards, to bring together all the people who are crucial to improving health across an area and having a real impact on the causes of ill health. We can bear down on the inequalities in health that widened under the previous Government.
	The Bill now makes our commitment to integration explicit. Clinical commissioning groups will have a duty to promote integrated health and social care based around the needs of their users, and we will encourage greater integration with social care by ensuring that CCG boundaries do not cross those of local authorities without a clear rationale.
	The Bill has deserved the attention and passion that it has attracted, and which I am sure it will continue to attract. I thank all Members who have taken part in the scrutiny of it on Second Reading, in Committee, on recommittal and during the past two days. I especially thank my ministerial colleagues, who have steered the debates and led the preparation of and speaking on the Bill. I thank all colleagues throughout the House who have contributed, especially many of my colleagues who I know have given an enormous amount of time, energy and hard work to supporting the Bill. I also thank the Whips.
	I thank the Officers of the House and, especially on this occasion, my departmental officials who have responded tirelessly not only to our requests for information and advice but to those of many hon. Members and thousands of people across the country and in stakeholder organisations.
	The intensity of debate and the brightness of the spotlight shone upon the Bill have made it a better Bill than when it was first laid before the House. I believe that it will set the NHS in England on a path of excellence, with empowered patients, clinical leadership and a relentless focus on quality. Let us look at what we have already achieved as a Government: more investment in the NHS, higher quality despite increased demand, waiting times remaining low, MRSA at the lowest level ever, mixed-sex accommodation breaches plummeting, and thousands more people getting access to cancer drugs. The Bill will pave the way for even more progress towards the world-class NHS that patients want, which will be able to deliver results that are truly among the best in the world. I commend it to the House.

John Healey: This Government and this Bill are giving health reform a bad name. The Bill is unwanted and unnecessary. It is reckless to force through the biggest reorganisation in NHS history at the same time as finances are tight and pressures on the health service are growing. The big quality and efficiency challenges that the NHS must meet, and the changes that the NHS must make for the future, will be made harder and not easier because of the Bill.
	I thank my shadow ministerial team, who have done such a sterling job. I also thank my Back-Bench colleagues who served on not just one, but two Public Bill Committees, and all my Back-Bench colleagues, who have given such strong support to the Opposition in the House.
	I should also pay tribute, if I may, to the stamina of the ministerial team, but I say this to them: we will not let up now, because in 13 years of Labour reform and investment, people saw huge improvements in the NHS, the lowest ever waiting times, and the highest ever patient satisfaction; but in this the first year of this Tory-Lib Dem Government, people have instead seen the NHS starting to go backwards. They have seen the Prime Minister breaking the very personal promise that he gave at the election to protect the NHS. As we heard at Prime Minister’s questions today, he and his team are in denial about the damage that his Government are doing to the NHS and the scale of criticism and opposition to it.
	The Prime Minister’s pause to listen was supposed to have won back public support and confidence among NHS staff. He failed. It is true that changes have been made to the Bill, but they make the NHS plans more complex, more costly and more confused. Millions of pounds will be wasted on new bureaucracy when it could and should be spent on patient care.
	As the House is asked to approve the Bill on Third Reading tonight, the essential elements of the Tory long-term plans to see the NHS broken up as a national public service, and set up as a full-scale market, are still in place. First, on the market, a new regulator will enforce competition law on the NHS for the first time, and it will have the power to fine hospitals 10% of their turnover for working together. The Office of Fair Trading will oversee mergers if a hospital’s turnover tops £70 million. There will be no cap on the number of private patients that are treated in our NHS hospitals as NHS patients wait longer. That means more legal challenges from competition lawyers, more privatisation and the closure of NHS services and hospitals. It means that much of the planning, collaboration and integration that is at the heart of the best of our NHS today will be very much harder, and perhaps illegal, in future.
	Secondly, the Bill betrays a founding principle of the NHS. For 65 years, people have known that the Secretary of State and the Government whom they elect are responsible for the definition and provision of a comprehensive health service. The Bill passes that power to at least 250 local commissioning groups and stops the Secretary of State directing them as to the services that they must provide for patients. It makes the Government unaccountable for what health services are provided and unable to guarantee patients a universal service. It is a fundamental and founding principle that
	our NHS is a national service, equally there for all, whoever we are, wherever we live. This Bill takes the “national” out of the national health service.
	In January on Second Reading, I said of the Government’s NHS plans that the more people learn about them, the less they like them. That was true then and it is true now, despite the many changes to the legislation. These are the wrong reforms at the wrong time, driven by the wrong ideology. Labour will continue to lead the challenge against these plans in the other place, and we will oppose this Bill tonight on Third Reading.

Several hon. Members: rose —

Nigel Evans: Order. As Members will see, we have only a very short time before I put the Question, so could they please be very pithy and short in their contributions in order to get as many Members in as possible?

Sarah Wollaston: The hon. Member for Bethnal Green and Bow (Rushanara Ali) spoke of health inequalities in her constituency. Perhaps she should look at the King’s Fund’s annual review of NHS performance between 1997 and 2010, which
	“identified the lack of progress in reducing health inequalities as the most significant health policy failure of the last decade.”
	Opposition Members should bear that in mind when they talk of a two-tier health service, because they fail to focus on outcomes and they fail to focus on inequalities.
	I welcome the duty of the Secretary of State, the NHS commissioning board and clinical commissioning groups to have regard to reducing health inequalities. Let us see something done about that scandal. I also welcome the work of the NHS Future Forum in setting out the central dilemma surrounding the role of the Secretary of State. The NHS should be freed from day-to-day political interference, but it must also be clear that the Secretary of State retains ultimate responsibility.

Debbie Abrahams: Will the hon. Lady give way?

Sarah Wollaston: I will not, because so many Members are waiting to speak.
	There has been real scaremongering about, in particular, the difference between the duty to provide and the duty to secure provision, but I believe that the wording simply reflects the reality. The key issue is the line between the ability to step in if things go wrong, and the very real need for politicians to step back and let clinicians and patients take control.
	I shall cut my speech short because I have been asked to be brief, but let me end by saying that, for three clear reasons, I would not be supporting the Bill if I thought that it would lead to the privatisation of the NHS. [Hon. Members: “Have you read it?”] I assure Members that I have read it in great detail.
	Let me give those three clear reasons. First, clinicians will be in charge of commissioning. Secondly, the public will be able to see what clinicians are doing. Thirdly,
	neither clinicians nor the public will allow privatisation to happen. They do not want it to happen, and neither do Members of this House.
	PCTs and foundation trusts did not meet in public, but they will do so in future, and it is the public and patients who will ensure that the NHS is safe in the hands of the Conservatives and the Liberal Democrats.

Nigel Evans: That is the length of speech that we like.

Rosie Cooper: I fear that for all the listening, the work of the Future Forum, the concerns voiced by health professionals and our constituents who rely on the health service, and the two days of debate in this place, we have ended up on Third Reading with something that is not substantively different from the original idea. Although it is three times longer than the National Health Service 1946 Act, which created the NHS, the Bill before us leaves us with more questions than answers. I suspect that that will remain the case for some time, as the Government have indicated that more amendments will be tabled.
	It is astonishing that we have progressed from a Bill that was never meant to be, because the Conservative party had promised no top-down changes to the NHS, to the Conservatives’ having a supposedly well-thought-out plan—which required a pause because of the sheer scale of the public’s and medical professions’ opposition—and then to the Bill that we have today, which needs more amendments. Sadly, the changes are not substantive enough. The Minister told us yesterday that 715 of the 1,000 amendments were intended merely to change the words “commissioning consortia” to “clinical commissioning groups”. I believe that the public, clinicians and those of us who could see right through the Bill were looking for something more substantive when the Government stopped to pause and promised to listen to people’s concerns.
	The Health and Social Care Bill that we now have is still as confused and muddled as on the day it was first brought before the House. I expect that Ministers hoped to confuse and bore people into submission. Disgracefully, the Government began to change the NHS structures without the consent of the people even before they produced the Bill, and they continue to do so even though it has not passed through this House or proceeded to the other place—where it is to be hoped that it will receive the thorough and tough consideration that we should have had the time to give it here.
	What we have is a Bill that is high on autonomy and low on accountability. It is supposed to be built on the principles of efficiency, reducing bureaucracy and cutting out waste, yet I do not believe it achieves any of them. In fact, in practice it does the opposite. The Bill will leave us with an organisational malaise, as the number of bodies and organisations significantly increases, with the relationship between them all being complex and incoherent and severely lacking in detail and accountability. The Bill leaves us with a financial challenge that has never been achieved in any health economy anywhere in the world at the same time as removing great swathes of the people with the experience and skills to deliver this outcome. The Secretary of State said that he admired NHS employees. If that is so, why have his policies led to so many of them losing their jobs?
	The Bill will leave the NHS open to European competition regulation, all of which will be overseen by an economic regulator enforcing competition who appears to think the system can be based on an outdated and failing regulatory model like that of the utilities sector, and whose accountability to Parliament and the Secretary of State is unclear. Ultimately, I believe the Bill has been driven forward as an ideological exercise, rather than through a desire to improve the quality of health care available to the people of this country. The Government could have achieved the changes they said they wanted without all this structural mayhem, such as by reducing the number of primary care trusts, changing the make-up of the boards and putting clinicians firmly in the driving seat, but perhaps that was not macho enough.
	This evening, the Government are in serious danger of consigning to the bin 13 years of progress, in which patients were being treated within four hours in accident and emergency and were guaranteed an operation with 18 weeks. Tonight, I genuinely fear that the Bill before us will be the equivalent not of throwing a grenade into the NHS, but of pushing the button on the nuclear option: a completely disproportionate response to the challenges facing the NHS.
	In my speech on Report, I referred to the former NHS employee Roy Lilley and his blog. Today, he takes a quote from Mary Anne Evans, otherwise known as the novelist George Eliot:
	“It is never too late to be who you might have been.”
	I therefore urge the Liberal Democrat Members of this House to consider whether they genuinely believe this Bill will deliver a better, more caring and more patient-led NHS.
	Earlier in the debate there were suggestions of scaremongering, so let me be clear: I am not scared; I am terrified—terrified that this Conservative Government will kill off the NHS, a system of health care that is envied throughout the world and that is being threatened for the sake of ideology. I am not scaremongering when I say that if this Government destroy the NHS, they will never be forgiven.

Nicky Morgan: In yesterday’s debate the right hon. Member for Holborn and St Pancras (Frank Dobson) said of the NHS that he believed that in most parts of the country and most of the time it does a good job for people, but I want to see it doing an excellent job for people in all parts of the country all the time, and that is what this Bill will achieve. Having served on the Bill Committee, it is a great sadness to me that that message, and the fact that patients will be at the heart of the NHS, has been lost in the months of scaremongering—a word used by the last speaker—and wrangling by those who have campaigned against it and have obscured all such messages. That has been totally unfair to the patients who rely on the NHS.
	I briefly want to make two points. First, Members who served on the Committee will know of my passion for getting the right treatment for mental health patients, and at a meeting of the all-party group on mental health yesterday the Bill was described by GPs as a great opportunity: an opportunity for the integration of primary and secondary care—something they have not had before, and that will now be achieved.
	Secondly, as my hon. Friend the Member for Totnes (Dr Wollaston) said, the Bill puts clinicians at the heart of commissioning. When the Bill was recommitted, my researcher said to me, “This Bill is a gift that keeps on giving.” Now it is time for this present to be handed over to the other place, but it needs to reach the statute book and we need to implement it on the ground. I have heard nothing from the Opposition in the past eight months to convince me that this Bill should not receive its Third Reading and get on to the statute book, and I urge all hon. Members to support it.

Nigel Evans: I am grateful for that short speech. I ask for another short speech from Kevin Barron.

Kevin Barron: I have been a Member of this House for 28 years and I have been active in different parts of health policy for many years, and I have never seen any Bill—not just any health Bill—come to this House so ill-prepared to be put on to the statute book. I served during the two stages of the Public Bill Committee. Largely, I asked questions where I wanted explanations, but I got very few answers. As was said earlier today, part 3 remains in this Bill and its 97 clauses bring in economic regulation. Only nine of those clauses have been amended since the Future Forum met and said that we were in deep trouble with this.
	What did the Future Forum ask for? It recommended that Monitor’s powers should
	“promote choice, collaboration and integration.”
	Monitor’s powers have changed somewhat, but the major change that occurred during the second part of the Committee stage was that the Government took away Monitor’s power to promote competition and gave it a new power to prevent anti-competitive behaviour. Perhaps, at some stage, somebody will be able to tell me what that means. Perhaps somebody will also be able to tell me the answer to something I asked in the first sitting of the Public Bill Committee: what do the Competition Commission and the Office of Fair Trading have to do with the mergers of two NHS trusts? The relevant Minister said at the time that that was a good question, but I have not heard it answered since.
	I must say, with all due respect, that no Labour Member argued that the NHS is perfect, nor would I do so. But this Bill is a dog’s dinner. The national health service and the nation do not deserve it, and I will vote against it tonight.

Stephen Dorrell: Like my hon. Friend the Member for Totnes (Dr Wollaston), I would vote against the Bill if I thought that it was going to promote the privatisation of the NHS. One thing that this Bill has in common with every health Bill I have attended in 21 years is that its opponents claim that it is about privatisation, but it is about nothing of the kind.
	As the Secretary of State made clear, this is a different Bill, in some important respects, from the Bill that was first presented. First, the Bill introduces a statutory duty to promote the integration of health and social care—Labour Ministers talked about that but never
	delivered it. Secondly, the Bill introduces new safeguards against cherry-picking by private sector providers—Labour Members say they were against cherry-picking but they never introduced such safeguards. Thirdly, the Bill introduces new safeguards in respect of the continuity of essential services provided by private providers, who were introduced by Labour into the delivery of health and social care—such safeguards were never provided by Labour. Fourthly, the Bill makes real a commitment to the introduction of the clinical leadership of commissioning—Labour talked about that in office but never in reality delivered it. So this is a Bill that has been changed and improved as it has gone through the parliamentary process.
	Let us not belittle the extent to which the Bill actually builds upon the same policies that were pursued by Labour in government: a policy of the extension of commissioning to act on behalf of the patient and the taxpayer; a policy to promote the development of foundation trusts as the best way of delivering care. This Bill takes 20 years of consistent development of policy and converts the words of Labour Ministers into reality. That is why I support its Third Reading tonight.

Michael Meacher: Extremely briefly, I want to put on record my view that the Government’s handling of this Bill has been a monumental abuse of the principles of accountability in this House. It was sprung on an unsuspecting nation after an election in which there was no mention whatsoever of these proposals, after an air-brushed Cameron advert said, “I will cut the deficit, not the NHS.” Despite those misleading signals, there has been no commission of inquiry to examine its philosophy or ideology, no proposal to pilot it—
	Debate  interrupted  (Programme Order, 6 September).
	The Deputy Speaker put forthwith the Question already proposed from the Chair (Standing Order No. 83E), That the Bill be now read the Third time.
	The House divided:

Ayes 316, Noes 251.

Question accordingly agreed to.
	Bill read the Third time and passed.

Access to a Lawyer

Jonathan Djanogly: I beg to move,
	That this House takes note of European Union Document No. 11497/11 and Addenda 1 and 2 relating to the Draft Directive of the European Parliament and of the Council on the right of access to a lawyer in criminal proceedings and on the right to communicate upon arrest; and supports the Government’s recommendation not to opt into the Directive in accordance with Protocol (No. 21) on the position of the United Kingdom and Ireland in respect of the Area of Freedom, Security and Justice to the Treaty on European Union and the Treaty on the Functioning of the European Union.
	I commend the European Scrutiny Committee for calling this debate. As set out in the coalition agreement, the Government approach criminal justice legislation case by case, with a view to maximising our country’s security, protecting Britain’s civil liberties and preserving the integrity of our criminal justice system. The Government recommend that the UK should not opt into this proposed measure at the start of negotiations, not because we do not think that minimum standards of defence rights, including access to a lawyer, and the right to communicate on arrest, including with consular authorities, are important—of course, we do—and not because we disagree in principle with the setting of common, minimum standards across the EU in respect of certain aspects of criminal proceedings. On the contrary, we see the benefit of appropriate minimum standards. For that reason, the UK opted into the first two measures on the procedural rights road map on interpretation and translation and the right to information in criminal proceedings. We are not making this recommendation because we fear that our law does not meet the minimum standards required by the European convention on human rights—it does.
	The reason we do not propose to opt into this measure at the outset of negotiations is that we think that the directive as published by the Commission would have an adverse effect on our ability to investigate and prosecute offences effectively. It is important that action is taken to ensure that the standards of procedural rights across the EU are adequate. That is necessary for two reasons: first, to ensure that, as people travel through the EU, they can be confident that in the event that they are unfortunate enough to become subject to the criminal justice system of another member state, they will be dealt with fairly and in accordance with robust minimum standards; and, secondly, the EU has chosen to develop a series of mutual recognition measures designed to promote security by helping to combat crime and ensuring that suspected offenders cannot use European borders as a way to escape justice.

William Cash: The Minister has twice used the words, “at the outset of proceedings”. Being something of an old hand at this sort of thing, I wonder whether that means that he proposes to opt in later. Perhaps he will bear in mind the problem that some other member states have judicial systems that are, quite frankly, below par.

Jonathan Djanogly: Indeed they do have systems that are below par, which is why we are keen for the measure to proceed across the EU. We will decide at a later date whether Britain opts in, subject to the negotiations that
	will take place. If my hon. Friend listens to what I have to say a bit further, he will hear how we propose to look at that process.
	This is a good, practical idea that has delivered some notable results, provided that it does not put suspects at risk of less-than-adequate criminal proceedings. Such instruments of mutual recognition were never intended to operate on their own. It was intended that they should be supported by a series of criminal procedural rights, enforceable at EU level, that would build on the rights already guaranteed by the ECHR and provide additional reassurance that the rights were being given practical effect in all member states. These standards will not only protect British nationals when they are arrested elsewhere in the EU but will provide greater trust and confidence among the courts of all EU states that judgments handed down, which they may be expected to recognise, have been made on the basis of sound procedural standards.
	Standards of procedural rights are high in the UK. The right of access to a lawyer, both before and during police interview, has been provided in England and Wales and Northern Ireland since the mid 1980s. A similar right was provided for in Scotland last year. However, despite the fact that we see value in the Commission tabling such a measure, we have considerable concerns about the detail of the directive and the impact its drafting would have on the UK’s criminal justice systems.
	The procedural rights directives are intended to draw on the jurisprudence of the ECHR and to flesh out what those rights mean in practice. Certain provisions of the Commission’s proposal, however, go far beyond the minimum standards that stem from the convention. While there is no problem in principle with going beyond the standards of the convention if there are good practical and policy reasons to do so, we do not see such reasons in this case. On the contrary, we think that there would be some quite adverse and costly impacts on the ability effectively to investigate and prosecute offenders were the Commission proposal to be adopted.
	Examples of that include the fact that the directive as drafted by the Commission may require access to a lawyer to be provided in some stages in the investigatory process where currently a lawyer is not provided, such as at a police search of a property or where a person’s fingerprints are taken when they are booked into a custody suite. We do not consider it necessary or proportionate to provide a lawyer in those situations.
	In addition, the directive requires that a person should always be able to meet his lawyer face to face, whereas we provide, in some minor cases, for telephone access, which detained persons often prefer as it can mean that they are held for a shorter period as it is not necessary to wait for a lawyer.

Kelvin Hopkins: The Minister has covered the point that I want to make. We permit defendants to telephone for immediate advice from a lawyer. It is quick, cheap, easy and very accessible for defendants.

Jonathan Djanogly: The hon. Gentleman makes a good point. That is exactly the case, and if it is to be under threat we should be concerned.
	The directive also requires absolute confidentiality of meetings and communications between a lawyer and a suspected or accused person. While confidentiality of such discussions is of course a fundamental principle, there are some limited circumstances in which confidentiality should not be guaranteed. The most obvious example is where the authorities have reason to believe that the meeting or correspondence is being abused to further criminal activity. In such circumstances, which are exceptional but none the less extremely serious, the communications ought not to be privileged and the authorities might need to monitor them.
	We also believe that member states should be allowed to derogate from other rights set out in the directive, in certain exceptional circumstances. For example, it might not be appropriate to allow a person in custody to contact a particular individual if the police might have reason to believe that he will ask that person to conceal or destroy evidence. The ECHR case law has been clear that restrictions can be imposed on access to a lawyer for an accused person if there are compelling reasons to do so.
	We do not think that the drafting allows enough discretion for judges to decide case by case whether evidence should be admissible if it has been obtained in breach of any of the rights set out in the directive.

Jim Shannon: In some of the documentation and information that Members received before the debate, there seemed to be a question about whether citizens of the United Kingdom would be disadvantaged with regard to the high level of legal representation that they have compared with that in the other 26 EU countries, which seem to have agreed on a method and the way forward. As a Member of the House, I would have to ensure that my constituents had that high level of legal representation, such that it was equal to that in the rest of the EU and that we were in no way disadvantaged.

Jonathan Djanogly: The straightforward answer is that if the other states were to go ahead with the directive and we did not opt in, British subjects travelling abroad would, I suppose, have the advantage of the minimum standards whereas other EU citizens would not have the benefits in this country. However, that is not the basis on which we are negotiating, because it would not be a good position from which to negotiate. That is the technical position.
	The changes that the directive in its current drafting would require us to make to our domestic law would not only be unnecessary, but would be highly resource- intensive. Our initial analysis suggests that the directive as drafted by the Commission could cost upwards of approximately £32 million to £34 million per year. I stress that the UK is not alone in having these concerns about the directive. The early negotiations made it clear that our concerns are shared by a good many other member states. The incumbent Polish presidency is taking a sensible and pragmatic approach to negotiations, and we can expect that the final product may be very different from the text we are looking at now and that many of the concerns that we have highlighted will be dealt with.
	Because of that, and because of the value we attach to ensuring fair trial rights across the EU, we intend to work very closely with other EU partners to develop a
	text that takes greater account of the practical realities of investigation and prosecution and allows for greater flexibility in meeting the requirements of ECHR jurisprudence. Given the extent of our concerns with the current text, we cannot at this stage be entirely confident that all of them will be taken into account, and it is for that reason that we are seeking not to opt in at the outset. However—I say this to my hon. Friend the Member for Stone (Mr Cash) in direct reply to his question—if our concerns are taken into account in the process of negotiation, we will be able to consider opting in at a later stage, as our protocol allows. Given the importance that we attach to this dossier, that is something to which we will give serious thought.

James Clappison: My hon. Friend is setting out the situation with great care and extremely competently. If we were to take the decision to opt into the directive, would we then be subject to the European Court of Justice’s jurisdiction in respect of what he described as very wide ranging matters to which we had opted in?

Jonathan Djanogly: The European Court of Justice has jurisdiction in determining how European law is to be applied, but it is not an appeal court so it would not constitute any type of court of appeal.
	I look forward to hearing the views of hon. Members on this recommendation and I commend the motion to the House.

Andy Slaughter: As the Minister says, the directive forms part of a defence rights road map agreed by the European Council in 2009 that aims for greater harmonisation of fundamental tenets of the criminal law. We have opted in and supported the previous two limbs of that. The current proposals concern principally the right to access to a lawyer on arrest, the right to have someone notified on arrest, and the right to communicate with a third party on arrest. As such—I do not think the Minister resiled from this—it articulates what most British people would consider not only uncontroversial but essential civil liberties. Since 2009 the EC has sought to harmonise these rights across Europe. I think the Government welcome that.
	Notwithstanding the points the Minister made, which I shall come to in a moment, it is difficult to see why the Government oppose the proposal as far as this country alone is concerned, at least for the present. If introduced, it would give us confidence that members of the British public would be subject to due process when overseas. According to the Foreign and Commonwealth Office website, more than 19 million British nationals travel to France every year, 13 million to Spain, 4 million to Italy and 2 million to Greece. Hundreds of them will, sadly, end up being arrested for a criminal offence. In Spain more than 2,000 Britons a year are arrested for criminal offences.
	As the Minister said, Europe is not a homogenous legal environment and not all justice systems operate in the same way or to the same standards. I am grateful for the briefing that Fair Trials International provided for the debate. The organisation helps to ensure a fair
	trial for anyone facing charges in a country not their own. In its research it highlights some notable examples. I shall not spend a great deal of time on that, as it would take up the time of other Members who wish to speak.
	Some of the cases are familiar, such as that of Garry Mann, a 51-year-old fireman and football fan who was arrested in Portugal, allowed to leave the country, subsequently arrested on an arrest warrant and imprisoned for two years. It was a case of mistaken identity and on arrest he did not have the benefit of a knowledge of Portuguese law, which would have allowed him a stay.
	Another case is that of Edmond Arapi, who was convicted in absentia of committing a murder in Italy at a time when he was working in the UK. It got to the point where he was about to be extradited and imprisoned for a term of 16 years. Had legal advice been available to him at the time of his arrest, it would have become apparent much earlier that this was a clear case of mistaken identity.

William Cash: I am reasonably familiar with the Arapi case because it took place in Staffordshire, not far from my constituency. Of course, the real mischief was the arrest warrant itself. There was no reason whatsoever why that man was dealt with in that way. I think that it is absolutely futile to attempt to argue the case on access to lawyers on the basis of the complete failure of the arrest warrant system.

Andy Slaughter: The hon. Gentleman makes part of my point for me. There are concerns about the operation of the European arrest warrant, but that is one of the reasons we wish to see the provision of good-quality legal advice and access to lawyers throughout the European Union. He might have his own solution on our relations with Europe, probably a rather more fundamental one than mine or the Minister’s, but we are where we are and it is therefore important that these safeguards exist.
	I was going to mention a third case, that of John Packwood. There are unfortunately a large number of such cases, but those are the three famous ones that have featured heavily in the UK press, particularly the Daily Mail, which has championed many of the cases in which the most perverse decisions have been made in foreign jurisdictions. For the people involved and their families, the experience was a nightmare. They were in a foreign country trying to communicate with officials who spoke an unfamiliar language and subject to procedures that were often summary and perverse, and yet they had no knowledge or advice with which to challenge them. It should be a matter of concern to the Government to protect our citizens overseas and ensure that they are given the same consideration as we would grant citizens of other countries visiting Britain, and that they are given the opportunity to do so and, at least for the present, decline.
	We should not be slow to see the high standards of justice that British people expect of our criminal justice system applied to other countries. The directive would assist that process. After all, it was the previous Conservative Government who enacted the Police and Criminal Evidence Act 1984, which provided a suspect in police custody with a statutory right to legal advice. Section 58 of the Act states that a person arrested and held in police custody is entitled to consult a solicitor privately at any time. The detention code provides that the consultation may be in person, in writing or by telephone and that
	free and independent legal advice is available. Therefore, the decision not to opt in to a directive that has the same intention as those provisions seems strange, and I will move on to what the Minister says are the differences.
	First, the directive’s requirements are broadly in line with current UK legislation. Where there are divergences—the Minister mentioned one or two—they are negotiable. This is a process of ongoing negotiation, and in some cases they are subject to the requirements of national law. The example of searches, which the Minister gave, is one of those.
	Secondly, the negotiations are continuing. As the Minister said, many other countries are concerned that there is inadequate room for derogation and are questioning aspects of the directive. It is therefore unlikely that it will remain in its current form. It seems pointless to send negotiating teams, as the Minister proposes, when we are the only country that intends to opt out at this stage, which fatally undermines the authority and leverage that this country will have. We appear to be throwing away an advantage to British citizens for reasons that are at best unconvincing and at worst spurious. Why have the Government taken this position? The Minister might have seen the briefing from JUSTICE, which takes the Government’s points of objection and states that they are either points that can be negotiated, or points that the Government have got wrong. It looks as though the Government are looking for reasons to opt out at this stage.
	Tomorrow, the Minister and I will meet again for the next Committee sitting of the Legal Aid, Sentencing and Punishment of Offenders Bill, and I look forward to that in Committee Room 12 at 9 o’clock. One of the first clauses that we will consider is clause 12, which gives the new director of legal aid casework and, by extension, the Lord Chancellor the power to decide who does and who does not get access to a lawyer in a police station—and to do so on the basis of an interests of justice test.
	There has already been an outcry throughout the criminal justice system at that attack on a basic right, which was introduced to avoid the risk of a miscarriage of justice. PACE itself was in part a response to the appalling miscarriages of justice of the 1970s, but, in answer to the criticism that the Minister is taking on a power that will allow the state to regulate who does and who does not get advice in a police station, he says that he has absolutely no intention of taking away legal help from police stations, so why is he then arrogating to himself the power to do so?
	Taken together with the premature decision tonight to opt out of the directive while negotiations continue and before any decision needs to be taken, clause 12 of that Bill suggests that the lessons that led to PACE are being forgotten by this Government.
	May I ask the Minister three questions, which, if he replies at the end of the debate, he may wish to answer? First, why are the Government not going to do what they did with the earlier stages of the road map and continue negotiations before making a decision on opting out? Secondly, why are they opting out now when there is further time to negotiate? And, thirdly, can the Minister confirm that the Government are committed to the current system of access to counsel in a police station and do not intend to erode that right, and if so explain why they are pursuing clause 12?
	The objections that the Government have raised are nugatory and susceptible to change, if there is any merit in them, whereas the advantages to British citizens abroad are clear and substantial. It is not good enough for the Minister to say that we can get all the benefits of the directive if it is enacted in 26 other countries, but that we do not need to bother with it ourselves. That sounds like a clear Eurosceptic “have your cake and eat it” voice from the Minister, and I am not sure that that is what he is saying, but it is a—[ Interruption. ] I am not sure that Government Members think that that is what he is saying, either, but it is a knee-jerk reaction to opt out at this stage.

David Nuttall: The hon. Gentleman has on a couple of occasions in the past couple of minutes referred to opting out of the directive, but we are not opting out, we are simply not opting in, and in fact there is a big difference, because if we opt in we will never be able to opt out.

Andy Slaughter: The hon. Gentleman makes my point for me. The Minister is at least open and clear about attempting to take the benefits. He wishes to do so, and in that I agree with him. Appalling miscarriages of justice occur regularly, and we want British citizens to be protected from that, but we cannot do so without engaging. We can negotiate what are for us as a country relatively minor changes, if changes at all are needed, but if we accept the experts who briefed Justice we find that the Government have misinterpreted those minor changes, to which the Minister alluded, in any event.
	In the end, it comes down to this: do we wish seriously to see the proposals implemented, in which case we should be in the game and negotiating clearly, or do we wish to take the Government’s somewhat disingenuous position tonight? For that reason, and notwithstanding the Minister saying that he may change his mind in due course, we will oppose the Government this evening.

Tom Brake: It is a pleasure and a relief to be called in the debate, partly because I gave relatively little notice of my intention to speak, and partly because I knew I would be coming immediately after the hon. Member for Hammersmith (Mr Slaughter). As other Members who serve on the Legal Aid, Sentencing and Punishment of Offenders Public Bill Committee know, sometimes he gets carried away with his eloquence and might well have risked eating into the entire time allocated for this debate.
	Obviously, I welcome the debate. As the Minister said, the new Commission proposal seeks to guarantee fair trial rights, providing access to a lawyer from the first stage of police questioning and throughout criminal proceedings by allowing adequate confidential meetings between the lawyer and the suspect; by allowing the lawyer to play an active role during interrogations and to check detention conditions by making sure that the suspect is able to communicate with at least one family member or employer; by allowing suspects abroad to contact their country’s embassy or consulate and receive visits; and by offering people subject to a European arrest warrant the possibility of legal advice in both the country where the arrest is carried out and the one where it is issued. The draft directive acknowledges that the right to a lawyer is not absolute and allows some derogation.
	As the Minister said, the UK affords most of the protections offered in the new proposal in existing domestic law. However, as the hon. Member for Hammersmith pointed out, in many other EU countries there is clearly not such provision; he quoted from Fair Trials International, which listed the countries in which, unfortunately, many of the rights that we have here do not apply. That is clearly why it is arguing for the UK to opt in to the directive.
	The Minister rightly set out the Government’s concerns about the provisions, some of which are not consistent with our national law or practice. Some of the proposals have financial implications for the UK, when, as we know from our debates on legal aid, there are real pressures on budgets. However, it is important to point out that other member states share many of our concerns about the practical implications of the proposal and the ability of their criminal justice authorities to investigate and prosecute crimes.
	In his letter, the Minister for Policing and Criminal Justice briefly set out the other issues about which the UK Government have concerns in respect of the impact on our legal system. I hope that the Government will pursue those matters because there can be no doubt that, as the Minister who is here today has acknowledged, the directive would benefit UK citizens abroad, many of whom have to put up with legal systems that are not comparable with ours. Equally, if the UK opted in, some aspects of the changes required might well be beneficial to other EU citizens who had to go through our own court system. I hope that there is an active engagement on these issues.
	My final point is about whether the UK Government’s approach is one of going in to win the battles around the differences and perhaps secure the possibility of opting in later, or whether we are going in to battle for a draw—to try to make some changes, but without the expectation that they would be sufficient to allow the UK to opt in. I hope that the Minister will be able to answer that point.

Debbie Abrahams: I will not be long, Mr Deputy Speaker; I just want to put on the record my opposition to the motion. The Minister made great play of the fact that it does not contravene the European convention on human rights, and suggested that cost was a key consideration in not opting into the directive.
	As I understand it from the legal opinion that I have heard, it is clear that the motion does conflict with article 6 of the convention and areas of PACE, as my hon. Friend the Member for Hammersmith (Mr Slaughter) has said. There have been a number of miscarriages of justice, such as the Garry Mann case; I understand that, because the directive was not in place, Mr Mann had only five minutes with his solicitor before he was convicted.
	I turn briefly to the impact of cost. If cost came before the consideration of human rights we would be on a very slippery slope; that would not be a sign of a civilised society—the one that I recognise that we belong to. I have spoken tonight because I wanted to register my objection to the motion.

William Cash: The European Scrutiny Committee recommended this subject for a debate on the Floor of the House, in line with the written ministerial statement that all matters of this kind would be so debated when they
	“have a substantial impact on the United Kingdom’s criminal or civil law”.—[Official Report, 20 January 2011; Vol. 521, c. 52WS.]
	This is a very good starting point. However, I am somewhat disquieted by the extent to which the Minister has indicated—I hope that I am wrong, and that he will correct me if I am—that it is only a matter of time before, irrespective of the matters of principle that arise, we might end up opting in. I remind him that the whole process of the opting-in arrangements is based on a presumption against our opting in unless there are profoundly good reasons for doing so.
	For the reasons that have already been touched on by the Minister and by the hon. Member for Hammersmith (Mr Slaughter), I believe that neither the difficulties that arise in relation to the application of arrest warrants nor the question of failures of justice in certain countries in the European Union may ever be sorted out. One need only look at a number of countries that came in by way of accession over the past few years. That went somewhat against the advice of the European Scrutiny Committee, and we had indicated beforehand that they had judicial systems that were so substantially below standard and riddled with corruption, with political judges and perverse procedures, that it was completely unacceptable that they should be allowed in. Access to a lawyer is obviously an important necessity, but whether one gets justice as a result of having such access when the courts themselves are corrupt is quite another story. That needs to be borne very much in mind.
	We all believe that when citizens of the United Kingdom go abroad they should have access to a proper judicial system when they get there. Sometimes they are arrested, as in the case of some of the arrest warrants. We have heard reference to the Arapi case and one or two others. I have the greatest respect for Fair Trials International; its representatives have given evidence to the European Scrutiny Committee, and they have been very impressive. They have grave reservations about the arrest warrant and have said so. Where there is a serious problem in respect of the judicial system of a given member state, the fact that one has access to a lawyer may be only a minor mitigating factor.
	Some time ago, before a lot of these laws were being put through, there was the case of the Greek plane spotters. Mr Arapi came from Staffordshire, and I noted what went on. My hon. Friend the Member for Staffordshire Moorlands (Karen Bradley) was instrumental in what happened. It was the subject of her first intervention in Prime Minister’s questions, and the Prime Minister immediately seized on it. I had a little word with her beforehand and suggested that it might be a good idea if she raised it with him, because I was convinced that he would immediately take the appropriate action, and he did. However, it took the intervention of the Prime Minister to sort this out, not access to a lawyer or to the judicial system where this poor man was convicted and sentenced to 16 years for an offence that he could not possibly have committed. The entire procedure that led to his conviction was utterly, completely and incontestably absurd, futile and dangerous.
	My concern is less about access to a lawyer and more about whether people get justice even when they have a lawyer. That might seem rather strange, but it is exactly the problem. I do think that being able to contact consular authorities is incredibly important. I would certainly go along with that.
	We have heard a number of points from the Minister, and I will briefly mention them, so as to put this on the record as Chairman of the European Scrutiny Committee. The potential consequence of article 10.2 and 13.2—of fettering the ability of a trial judge to decide on a case-by-case basis whether evidence should be admissible if it is obtained in breach of the directive’s provisions—is one problem. The other, as the Minister has indicated, is the financial implications of article 4, about providing a face-to-face meeting with one’s lawyer. As the Minister said, it is suggested that the cost of providing that could be as much as £32 million to £34 million a year. Another problem is the precluding of the use of accredited representatives. Those are people who are trained to advise a suspect at a police station. Even though they are not qualified lawyers, they at least provide a degree of assistance.
	There is also the issue of the European convention on human rights, about which it is well known that I am not wholly enthusiastic, to say the least. It would be far better if, having drafted the European convention on human rights, we had been aware that we are quite capable of passing legislation in our own country to protect people’s human rights. The idea that I am not in favour of human rights, which the Home Secretary put to me the other day, is positively absurd. Of course I am in favour of human rights; I just want them to be real ones.
	I am afraid that quite often artificial constructions are placed on the European convention on human rights, which have been criticised by some distinguished judges. The Lord Chief Justice himself said that the first duty of judges is not to apply Strasbourg decisions in the UK courts, but to protect the common law. A tremendous industry has been created since the 1990s, and the extent of human rights law has now reached astronomical proportions. It provides lawyers with a useful source of income without giving a proportionate degree of protection to those who seek human rights. Human rights could be provided for in Westminster if we passed our own legislation.
	Another question is what effect an EU proposal would have if it failed to improve fair trial standards in our own criminal law. Even if it attempted to improve trial standards in other countries, what effect would it have on our criminal law? If the EU proposal had no effect it would become a lot easier to support it, with all the reservations that I have already expressed.
	This afternoon, the Lord Chancellor gave evidence to the European Scrutiny Committee on the accession of the EU to the European convention. I assure hon. Members that he made it clear that that is a very, very long-term proposal, with huge degrees of negotiation yet to happen. Apart from that, there must be unanimity all the way down the line. He even ventured to suggest that it might not happen in his lifetime, or at any rate in his political lifetime.
	We have to bear in mind the complexities that are being developed. The European convention, as it relates to the citizens of this country and others abroad, interwoven
	with the charter of fundamental rights under the Lisbon treaty, which of course we voted against but which the Government are now implementing, produces the curious result of a multiplicity of complex procedures all overlapping with one another. It is important that we bear that in mind, because it would have a bearing on cases such as those that we are discussing.
	As I have said, given that we have tried and tested procedures, my preferred option would be not to opt in. I have grave reservations about the tsunami of opt-ins that we have been seeing.

Henry Smith: Is not the fundamental problem with EU opt-ins that if we opt in there is no way back, so if our negotiation is not successful we are stuck with whatever is decided, but if we choose to opt out we are not part of the negotiations? That means that if we opt in at a later stage we get the worst of both worlds. That is a fundamental flaw of the European Union and the opt-in system.

William Cash: I very much agree with my hon. Friend, who is also on the Committee and witnesses these things at first hand. The Committee recommended this debate, and I am glad that it is taking place. It is not a token exercise, and I trust that the Minister understands that there are serious reservations about how the judicial system operates in other countries. Although we certainly believe that access to a lawyer and to consular authorities is a good idea, we do not have to have the Lisbon treaty, the European Union or an opt-in procedure under those arrangements to provide for access to the courts or to secure protection for those who need it.

David Nuttall: I add my thanks to the European Scrutiny Committee and my hon. Friend the Member for Stone (Mr Cash) for ensuring that we are having another of our regular Wednesday evening debates on European matters. I am also pleased to say that for once I can support the Government’s present position on this issue, although I have to say that I am a little concerned that I might not be so readily able to support what might come in future.
	When any of our constituents travel abroad, they do so in the full knowledge that they are entering a foreign country with foreign systems. It seems to me that the fact that there are inadequacies in some of the legal systems of other European Union member states is not a good reason to accept another dollop of European legislation.
	I have heard no one suggest that our own procedures and legal systems in this country are not up to scratch. In fact, as far as I can see, it is a case of the rest of the Europe catching up with the systems and procedures that we already have in place. Of course, if we were ever to opt into the directive, we would have to change some of our existing procedures that have served us well. In my short time in the House, I have never had anybody complain to me about the procedures that we have in place in respect of access to a lawyer, the right to consult a lawyer when detained or any of our pre-charge procedures.

Nigel Dodds: Whatever one’s view of the current procedures within the UK, surely it is for the House and the UK to decide whether
	there are to be changes, on the basis of the arguments, which should be fully explored and discussed beforehand, rather than changes coming about as the by-product of a European directive. That is the problem if there are to be changes in the UK system.

David Nuttall: The right hon. Gentleman makes an extremely valid point. I would have made the same point later, but I shall make it now. I have heard no complaints about our current procedures, but if there were a general acceptance that an aspect of them could be improved, it would be for the House to pass legislation to do so. We would then have the right to tinker with and change them as we wished. Indeed, we have done so. Only very recently, a Delegated Legislation Committee on which I sat altered the rules under the Police and Criminal Evidence Act 1984, because this House thought it appropriate to do so.

James Clappison: My hon. Friend is making an important point in response to the one made by the right hon. Member for Belfast North (Mr Dodds). Has my hon. Friend turned his mind to the bigger picture? These opt-ins do not come before the House by accident or by way of judicious fine-tuning of our system. This measure is part of a political project that was put in place by the EU to create a European area of freedom, security and justice, whereby rules and laws on criminal procedures and other criminal matters will be made at the EU level rather than in this House, and whereby our law will be subject to that law.

David Nuttall: My hon. Friend makes another extremely valid point. Whenever I have discussions on European matters with constituents and other members of the public—not surprisingly, I have such discussions fairly frequently—time and again they refer to the fact that they are dissatisfied with our membership of the EU because they believed that the EU was to do with business and trade. They believe that the EU should have no part in justice or home affairs. When we entered the EU all those decades ago, it was never envisaged that the EU would play a part in justice and home affairs. That is one reason why I will continue to push for a referendum. Such things may have been in the minds of those who were pushing for the European project, but they were never in the minds of our electorate. They were never told about that and it was not part of their consideration when they went to vote back in the 1970s.

William Cash: May I remind my hon. Friend that the Conservative party, for the first time since 1972, was completely united in opposing the implementation of the Lisbon treaty? Only as a result of entering into the coalition agreement did we end up having to accede to many of the provisions that result from the introduction of a treaty that we were previously united in opposing.

David Nuttall: My hon. Friend makes an excellent point. That is one reason why opposition to our membership of the EU is growing in this country. As I often say to people, in many ways every directive that passes is another nail in the argument of those who will one day argue in a referendum—I believe we will eventually have one—that we should stay in the EU. People are increasingly
	fed up with the ever-growing competences of the EU. It is all very well to argue that the European Union Act 2011 will put an end to all these things, but we can see—day by day, week by week, month by month—that slivers of competence are going to Europe, and this would be another of those slivers. If the directive were adopted, it would be a classic example of this country’s handing over a further tiny piece of its competence. It might be only a sliver, but this is still a matter of sovereignty. At present, we can decide what our rules are.

Jacob Rees-Mogg: Is this not also a classic example of the European ratchet? First the European arrest warrant allows British subjects going about their lawful business in their own country to be arrested by foreign Governments; then it is decided that there must be basic standards to protect them from such action, because that is only fair and proper; and that then leads to the conclusion that there must be more harmonisation of the criminal law across Europe. In fact, what Her Majesty’s Government should be doing is not just not opting into this, but getting out of all the other measures to which they have agreed.

David Nuttall: My hon. Friend has made an excellent point, which I am sure would find widespread support outside the House. Far too much legislation from Europe is already foisted on our constituents, and we certainly do not need this as well. It is, in my view, an example of a solution looking for a problem. There is certainly no great clamour for it. When our constituents go abroad, they may well choose to go to Europe—there are, after all, another 26 countries in the European Union—but they may equally choose to visit any of the other 170-odd countries in the world, where none of this would apply. What do they do then?
	We ought to consider speaking—quietly and diplomatically, of course—to plenty of other countries which have judicial systems that are far less helpful to the accused than any that might be found in the European Union. This is, I submit, a criminals’ charter. If it were to become law, the criminals and their lawyers would not only have to comply with the Police and Criminal Evidence Act 1984, but would have recourse to this directive as well as the European Rights Act 1998 and the European convention on human rights. It would be yet another hurdle for our police to surmount in dealing with crime and disorder on our streets, and, in my opinion, a problem that we could well do without.
	The other group of people who would profit from the directive are the lawyers, particularly legal aid lawyers. As has already been mentioned this evening, it has been suggested that advice be given face to face. I know from my own experience many years ago that when a suspect is arrested, advice is given quite adequately on the telephone, and I see no reason to change that arrangement. Again, there has been no clamour for it to be changed. I see no reason why this country should have to change its practices and procedures purely on the basis of this directive. It may well benefit other countries—indeed, it may well benefit some of our constituents when they travel abroad—but I feel strongly that there is no need for it to be adopted now or at any time in the future. I hope that even when the negotiations have been completed, this will be the last that we hear of it, and that we shall never see it back on the Floor of the House again.

Jonathan Djanogly: This has been a constructive debate, and it has provided a timely opportunity to place the Government’s position on the record. Let me reconfirm, not least for my hon. Friends the Member for Stone (Mr Cash) and for Bury North (Mr Nuttall), that we believe it is important that action is taken to ensure that the standards of criminal procedural rights across the EU are adequate—I stress the word “adequate”. That will help to ensure that British nationals in other member states receive the rights that underpin a fair trial. It will also help to provide the level of mutual trust necessary to support European legal instruments that require competent authorities to accept and act upon decisions or judgments given in other member states.
	The Government see clear benefit in setting minimum standards across the EU in respect of certain aspects of criminal procedure. As many Members have noted, standards of criminal procedure in relation to access to a lawyer and the right to communicate upon arrest are high in the UK. We see benefit in an effective and workable directive which would raise standards in this area.
	The Opposition spokesman, the hon. Member for Hammersmith (Mr Slaughter), asked a number of questions. He asked why the UK had opted in to the previous two directives on the procedural rights road map, but not this one. The Government believe it is important that action is taken to ensure that the standards of criminal procedural rights across the EU are adequate. The previous Government opted in to the directive on interpretation and translation in criminal proceedings, and this Government opted in to the victims directive. The hon. Gentleman asked why we opted in to that directive, but not this one as well. The Government have decided to opt in to the victims directive establishing minimum standards for the rights, support and protections of victims of crime because it meets the criteria set out in the coalition agreement with regard to EU justice and home affairs measures and is more in line with existing UK practice. I can confirm to the hon. Gentleman that we currently intend to retain free legal advice in police stations, as I have said publicly in the past, and he will hear more on that in Committee tomorrow.
	The hon. Gentleman and my hon. Friend the Member for Stone mentioned individual examples of process, on which the Government cannot comment. However, I noted the disappointment of the hon. Gentleman and the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) about the fact that we do not intend to opt in at the outset.
	I also understand the disappointment of Members who have set out the difficulties faced by constituents who have faced trial in certain other EU member states. However, the directive as published by the Commission goes very much beyond what we see as the minimum standards of the European convention on human rights and would have an adverse and exceptionally costly impact on our ability to investigate and prosecute offences effectively. We do not think it would be sensible to opt in to the directive at this stage because it is not possible to be completely confident that all these difficulties could be mitigated through negotiation.
	I thank my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) for his supportive remarks, and I can confirm that we intend to negotiate and win on our positions. In order to do so, we intend to work
	very closely with our European partners—that work is already under way—to develop a text that takes greater account of the practical realities of criminal investigations and prosecutions. We are not alone in our concerns, and we are optimistic that the directive that is finally adopted might look rather different from that published by the Commission.
	Our aim during negotiations will be to amend the text constructively, so that the UK might be in a position to contemplate participating in the final directive, and we have three months from the proposal in which to opt in. We can be part of the negotiations if we do not opt in, but we would not have a vote, so we intend to participate in, and influence, negotiations to make the directive better. We would opt in post-adoption only if our criteria were met, and following appropriate consultation in Parliament. I can confirm to my hon. Friend the Member for Stone that there is no inevitability to opting in, and I understand many of the concerns he raised. At the same time, I have to tell him that there is no presumption against opting in unless there are profound reasons for doing so, such as he suggested.

James Clappison: If the decision is taken to opt in—which I would regret, for reasons I have explained—I hope it will be made clear that our Government are opting in to a major piece of criminal justice legislation and choosing to hand over to the EU and the European Court of Justice jurisdiction over a wide swathe of our criminal procedure.

Jonathan Djanogly: We will still have jurisdiction over criminal procedure, and subsidiarity would apply as well, but my hon. Friend makes his point.
	Any decision to opt in at a future date will be taken on the basis that the Government approach legislation in the area of criminal justice on a case-by-case basis, with a view to maximising our country’s security, protecting Britain’s civil liberties and preserving the integrity of our criminal justice system. Any decision to opt in at a future date would also be subject to scrutiny in Parliament.
	Question put.
	The Deputy Speaker’s opinion as to the decision of the Question being challenged, the Division was deferred until Wednesday  14 September  (Standing Order No. 41A).

Business without Debate

DELEGATED LEGISLATION

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Terms and Conditions of Employment

That the draft National Minimum Wage (Amendment) (No. 2) Regulations 2011, which were laid before this House on 20 June, be approved.—(Norman Lamb.)
	Question agreed to.

European Union Documents

Motion made, and Question put forthwith (Standing Order No. 119(11)),

A New Response to A Changing Neighbourhood

That this House takes note of European Union Document No. 10794/11, relating to a new response to a changing neighbourhood, and Addenda 1-16, detailing the results and recommendations of the Commission’s review of the European Neighbourhood Policy
	and a report on implementation of the European Neighbourhood Policy during 2010; and supports the Government’s approach as set out in the Explanatory Memorandum submitted by the FCO dated 3 June 2011.
	—(Norman Lamb.)
	Question agreed to.

DELEGATED LEGISLATION (COMMITTEES)

Motion made,
	That the Motions in the name of Sir George Young relating to the Electoral Commission and the Local Government Boundary Commission for England shall be treated as if they related to instruments subject to the provisions of Standing Order No. 118 (Delegated Legislation Committees) in respect of which notice has been given that the instruments be approved.—(Norman Lamb.)

Hon. Members: Object.

PETITION
	 — 
	Leacroft Surgery (Crawley)

Henry Smith: I am very grateful to have the opportunity to present a petition on behalf of many of my constituents.
	The petition states:
	The Petition of residents of Crawley,
	Declares that the Petitioners are concerned by the current proposals to close a general practitioner’s surgery in the Crawley Borough Ward of West Green.
	The Petitioners therefore request that the House of Commons urges the Government to take all possible action to ensure that Leacroft surgery is able to maintain health service provision in the area.
	And the Petitioners remain, etc.
	[P000953]

FUTURE OF THE BBC

Motion made, and Question proposed, That this House do now adjourn.—(Norman Lamb.)

David Amess: It was a childhood ambition of mine, at the age of 11, to become a Member of Parliament, and I was fortunate enough to be elected in 1983. I remember, as if it were yesterday, first arriving here and being told that this is the mother of Parliaments, that we are sovereign, that this is where laws are made and that Parliament existed to support parliamentarians with their duties. An enormous number of changes have taken place since I was first elected, and I have various question marks over the way in which this place is run these days. However, I am delighted to have the opportunity to raise an important issue that we take for granted—the British Broadcasting Corporation.
	I am not using this Adjournment debate to attack the BBC—indeed, I have many friends and some relatives who work for it. However, as this place has been greatly diminished and we were under siege before the previous general election, I made a beeline for the BBC’s chairman and chief executive when we were invited to attend a reception held by the BBC after the election. I told them that I was very concerned about the way the BBC is run and about the salaries that both of those gentleman are paid, and I will discuss that in due course.
	The BBC is a blue-chip company of which we can be very proud. Its first transmission was from the roof of Selfridges in 1922. The first royal address was broadcast in 1924, and in 1932 we had the first Christmas address from His Majesty, the then King. I do not think that anyone in the Chamber remembers 1940, when Churchill made his rousing speeches, but the BBC also deserves credit for those. In 1945, there were the wonderful Dimbleby’s revelatory reports about the terrible happenings in Belsen concentration camp. We have the Olympics next year and in 1948, the BBC broadcast the Olympic games. Then, 1960 saw the construction of Television Centre, the first purpose-built TV centre in the world. We then go on to 1982 and Brian Hanrahan’s unforgettable news reporting of the Falklands war. In 1990—it is ironic that the hon. Member for Great Grimsby (Austin Mitchell) is in the Chamber, because he and I held different views—we saw our proceedings televised. I was dead against that and I voted against it, but, anyway, our proceedings are now televised. The BBC had an exceptional global reputation for being an excellent source of unbiased and impartial news. Indeed, it was groundbreaking and it was known for having remarkably high journalistic integrity in its reports.
	The BBC is:
	“Institutionally biased to the Left”
	and that is a “mindset”. Those are not my words, but those of Peter Sissons in an article in one of our newspapers this year. He said that there were
	“basic journalistic mistakes—wrong dates, times and numbers…and basic political or geographical facts”
	were wrong. The BBC tends to run positive stories in favour of the UN and the European Union. When it comes to reports relating to Israel, it only ever half tells the story, favouring stories that show Israel in a poor
	light and failing to report the rest of the facts—I think in a highly disproportionate manner. For instance, there is an humanitarian disaster waiting to happen in Camp Ashraf, so why do we hear nothing about it? There is a terrible situation in Syria, but we do not hear from relatives of President Assad who do not think he is a terribly good leader.
	More poignantly, the BBC is fervently anti-cuts and ensures that that message pervades every aspect of BBC programming. Since the general election, the BBC has embarked on a consistent policy of criticising Government actions, which is rather amusing given that the director-general declared that bias at the BBC—he said it, so he must recognise that there was bias—was a thing of the past.
	Over the past few days, we have seen that the former Labour Prime Minister was very friendly with Mr Gaddafi in 2004. A book has now been published that shows that there were tensions at the highest echelons of the previous Labour Government. Given the BBC’s high expertise in investigative journalism, it is puzzling that none of those things was brought to the fore at the time. We need only to think of “The One Show”, which recently ran a segment in which a presenter asked the Prime Minister, “Are you too much of a toff?” Another asked him, “How do you sleep at night?”
	The BBC uses the term “independence”—I am still citing Peter Sissons—to mask the fact that it positions itself to serve its own best interests. For example, preference was given to Tony Blair’s party conference speech in 1995. Alastair Campbell berated the BBC editor to give the story precedence above all others based on the speech’s proximity to the next general election. That was what happened.
	The BBC consistently gives left-wing politicians and figures a platform to spout policy and denounce the Government. Examples include the differing treatment of guests from different ends of the political spectrum on shows such as the “Today” programme. How politicians allow themselves to be treated so badly on the “Newsnight” programme, and on “Question Time” and so on, I do not know.
	One thing that is particularly unforgivable is the constant practice of presenting the opinion of BBC correspondents as fact, as summed up by Peter Sissons, the former long-time BBC news presenter, in an article earlier this year. He said that “the increasing tendency” at the BBC is
	“to interview its own reporters on air…Instead of concentrating on interviewing the leading players in a story or spreading the net wide for a range of views…It is a format intended to help clarify the facts, but which often invites the expression of opinion. When that happens, instead of hearing both sides of a story, the audience at home gets what is, in effect, the BBC’s view presented as fact.”
	I know that I am biased, but we are blessed with an absolutely splendid Home Secretary and a first-class Secretary of State for Culture, Olympics, Media and Sport. I do not criticise them regarding the challenge that lies ahead. In the past, after each election, the new Home Secretary has invited colleagues to come and talk about licensing and whether we should do away with it, but that has not happened this time. One of the main reasons why the BBC is so financially stretched is the cost of digital-only stations such as BBC 3. This youth-orientated channel costs £119 million a year. Shows on it include, “Snog, Marry, Avoid?”, “Total Wipeout”,
	“Young, Dumb and Living Off Mum”, “Don’t Tell the Bride”, “Underage and Pregnant” and “Jamelia: Shame About Single Mums”. However, I am delighted that Mr Gareth Gates, whom we were honoured to have in the Palace of Westminster today to address the all-party group on speech and language difficulties—he had a speech problem himself—will be appearing on BBC 3 in November on a programme about people with speech difficulties. BBC 4, the more high-brow channel costs £74 million.
	I want to focus on the salaries of executives, because I now realise, as a Member of Parliament, that it is not the workers who are at fault in so many sectors of life but the management. The salaries that the management of the BBC are paid are absolutely ludicrous. The director-general is paid £838,000—this is madness! Other directors’ pay, as of March 2011, are: £488,000; £517,000; £467,000; and £452,000—not to mention what the financial controller gets. At 31 March 2011, 13 executive directors had cost us, the British people, £4,792,000, but we Members of Parliament are castigated for what we earn, and the electorate can get rid of us through the ballot box.

Jason McCartney: Let me give my hon. Friend an opportunity to take a breath of air after pouring out all those huge figures. Does he agree that it would be totally grotesque if BBC local radio, which is in touch with local communities, had to suffer cuts while those huge salaries were being paid out? In my part of Yorkshire, BBC local radio not only reports local sport such as Huddersfield Giants rugby league and Huddersfield Town football club, but is a valuable service when there is heavy snow, because it lets people know whether the schools are open, which shops are open and which roads are open or closed. People who cannot get out and about love their BBC local radio, and it would be totally grotesque if those salaries were still being paid while BBC local radio was being cut.

David Amess: I absolutely agree with my hon. Friend. One cannot watch TV while driving a car, but one can listen to the radio. I love radio—Essex Radio is fantastic. I absolutely agree. Frankly, these BBC radio stations have been starved of cash, if you look at some of their software.
	The director-general proposed that the executives could increase their annual pay by tens of thousands of pounds through a policy known as “earn back”. I must say that I have the highest regard for Lord Patten, the current chairman of the BBC. I once had the honour of being his private parliamentary secretary for a week, not because I was useless but because my former colleague, Robert Key, had been appointed as a Minister and I stood in for a week. Lord Patten is going to be a wonderful chairman of the BBC. Under the director-general’s proposals, however, the seven members of the BBC’s executive board, as well as the corporation’s 540 senior managers, would have been able to earn an extra 10% on top of their salaries by beating performance targets. The proposal was accepted by the BBC’s executive remuneration committee, but I am delighted to say that the new chairman stepped in and dealt with the issue. It just shows how out of touch they are.
	I now move on to the presenters. I do not know whether we have brilliant presenters. I would just say that I find it slightly annoying that when one or two
	female presenters—I do not know whether they have had too much Botox or something—are presenting the news on a very serious subject, they smile. But their salaries, which we are paying for, are worth looking at. The highest paid stars’ earnings from the BBC cost 1.55% of the £3.49 billion that the licence fee brings in. That is huge.
	The seven high-profile presenters involved in this year’s coverage of the Glastonbury music festival for the BBC were not only paid lots of money for going, but given complimentary tickets. Why did the BBC send 400 journalists to the Glastonbury festival? All this goes unquestioned. We are concentrating now on phone hacking and so on. If Parliament was as it used to be, we could properly scrutinise these things.

Jim Shannon: The hon. Gentleman has mentioned performance targets. Does he agree that if there have to be performance targets, they should be based on the satisfaction of the TV licence holders, and that plenty of them are dissatisfied?

David Amess: I am going to call the hon. Gentleman my hon. Friend. I absolutely agree with his point, and I hope that will be a subject for another debate.
	To save money, headquarters are moving to Salford. Well, I am sorry: London is the capital city. Other TV channels have found that London is the best place for programmes to be based. Indeed, ITV moved “This Morning” to London because it could not get guests to travel to the studio in Liverpool. There are fears that the corporation’s move to the north could turn out to be an £877 million white elephant. It is understood that the BBC has had to offer incentives for people to move to Salford.
	On sport, I am sure that many hon. Members used to love watching cricket on the BBC, and wall-to-wall coverage of Wimbledon and so on. “Test Match Special” was so special. Well, all that has gone and now constituents are contacting me about Formula 1. We even had all the anti stuff against Andy Murray. Okay, he is Scottish; let’s get over it. He is a fantastic tennis player.
	I end with a thought about the licence fee. I am delighted that the Government have frozen it at £145.50 until April 2017. That amounts to 40p a day, which for lots of people actually mounts up to quite a lot. The completion of the digital switchover in 2012 would be a good time to think once again about how the BBC is funded. The British Broadcasting Corporation is a jewel in our crown, if it is well run and managed. It is pointless to have Adjournment debates unless hon. Members’ arguments are listened to. Mr Deputy Speaker, I hope that my words have been listened to and that there will be changes in the ridiculous high salaries that are being paid.

Several hon. Members: rose —

Nigel Evans: Order. I remind Members that the debate finishes at 8.47, and I am sure that we want to give the Minister time to respond.

Austin Mitchell: I am grateful for a little space from the Minister’s table to comment, because I will not follow the hon. Member for Southend West (Mr Amess) in his ludicrous accusations of bias in the BBC, about which he is as wrong as he was all those years ago about televising Parliament. However, he mentioned, in his back-handed way, quality in the BBC. We are about the get the document, “Delivering Quality First” from the BBC, in which it will tell us how it will deliver a 20% reduction in spending and a 25% reduction in overheads. That is far more than can be gained by any reduction in fees paid to Jonathan Ross or “Paxperson”, or even in the director-general’s ludicrous salary.
	This is a serious issue, because cuts cannot be made on that scale without damaging the BBC’s quality of production. This is a national jewel—a national asset—and we propose to inflict devastating cuts in production and staff, in the BBC’s scope and artistic integrity and, above all, in quality. Quality costs in television, and it must be financed.
	Here we are damaging this precious asset as a result, it seems to me, of a dirty deal that was arrived at between the Conservative party and the Murdoch interests. In return for the Murdoch newspapers’ support, the Conservatives agreed in opposition to prune the BBC, as James Murdoch had asked for in his MacTaggart lecture, and to give them the ability to take over Sky. Part of that deal has now fallen through, but it is important—I wish the hon. Gentleman had mentioned this—to stop the decimation of services in the BBC. It must be stopped.
	Far from using the licence fee as a stranglehold on the BBC to enforce reductions, we should pass at some stage a supplementary licence fee increase to save it from these cuts, which will be compounded by taking on the burden of the World Service. It is not now a matter of grumbling about bias at the BBC and making snide remarks about the salaries paid at the BBC. It is not now a matter of handwringing; it is a matter of fighting to save the BBC.

Robert Halfon: I congratulate my hon. Friend and near neighbour the Member for Southend West (Mr Amess) on securing this important debate. I believe that I can set out the answer to the problems that he has talked about this evening. I have campaigned since becoming a parliamentarian for the democratisation of the BBC licence fee. I have presented a ten-minute rule Bill and tabled many motions and questions on the subject. I agree with him that the BBC is a jewel in the crown. I think of the quote from Shimon Peres, who said that the BBC makes
	“dictatorship impossible, but democracy intolerable”.
	I, like my hon. Friend, love Essex Radio and “Look East”. We know that they provide essential services for people in my community, but the problem is that we are compelled to pay for the BBC and have no say over its cost or programming. The BBC is monopolistic, with about a third of TV viewing and half of radio, but it does not need to make a commercial return, so other providers are crowded out. We have no recourse and no means of redress. I do not object to the licence fee; I would be happy to pay double.

David Nuttall: My hon. Friend says that the BBC is a jewel in the crown, but what percentage of the British public does he think would purchase a licence if doing so were not compulsory?

Robert Halfon: If my hon. Friend waits, I will answer his question in a second. I would pay double for the licence, but the problem is that we have taxation without representation. We do not tolerate that in politics, and there is no reason why we should tolerate it in our public media.
	Under my private Member’s Bill on 25 November, the BBC would have to set out an annual plan and licence fee payers would vote. It is quite astonishing that licence fee payers had no say over the appointment of Chris Patten, whatever his merits might be. To those who say that voting would mean a decline in quality, I say that that attitude is mixture of ignorance and snobbery—ignorance because there is a market for quality, as Classic FM and other quality media show, and snobbery because that is like saying that the public should not be free to choose for themselves.
	Mine is not a radical proposal. Company shareholders have the right to hire and fire their boards. Residents have the right to elect their MPs and councillors. Given that we are supposed to be the BBC’s owners and are compelled to pay for it, we should democratise the licence fee immediately and give licence fee payers the vote.

David Morris: I have been listening to the views expressed by hon. Members and I agree with quite a lot of what has been said, but the House should consider the fact that the fears and complaints expressed about monopolies in the media when News International attempted to take over Sky were taken on board by the Government, yet we hear no real complaint about the BBC’s monopoly, which reaches far more widely.
	There is a lot of talk of cuts, but look at the quality of television programmes: as my hon. Friend the Member for Southend West (Mr Amess) said, we have all those reality programmes, such as “Snog, Marry, Avoid”, which are ridiculed by the public and in the media. Is that what we want to spend our money on? I do not think it is. Look at the ratings, which are dropping off and have been doing so steadily since 2000, when the reality TV boom occurred. We are ploughing all that money into the BBC without getting back programmes of the right quality. Efficiency is what we are trying to achieve, not stifling the BBC with cuts. We are trying to get the right deal for the public.
	It has to be borne in mind that the Government have spent a lot of time and energy on ensuring that local communities have greater influence over their local services, yet that has not been applied to the BBC. Are we aware that the BBC does not feel that it should be included in this and be subject to the public’s views? Listen to local radio: it is stifled in its approach to what it broadcasts.
	As more of our local papers move to online versions, does the House share my fear that non-commercial BBC websites might put them out of business, cutting choice for local residents? The BBC is an institution that we should protect, but the charge of cuts that is
	being thrown at the Government is the wrong one to make. The issue is quality within the BBC. That is the point I wanted to put before the House.

Edward Vaizey: We have had a good debate, long after the House concluded the rest of its business, and the fact that so many hon. Members wanted to participate shows that it could have gone on for much longer. I hope that the hon. Member for Great Grimsby (Austin Mitchell) will tell his Front Benchers that they should initiate an Opposition day debate on the future of the BBC, because there is nothing that hon. Members enjoy more than having a good old debate about the good old BBC.
	May I therefore congratulate my hon. Friend the Member for Southend West (Mr Amess) on introducing the debate and say how much I enjoyed his speech? I hope that I am not breaking a confidence if I say that before the debate he told me that he had a lot to get off his chest, and he certainly did. He started with praise for the BBC, and it is right and proper that we acknowledge that the BBC is one of the finest broadcasters not just in this country, but in the world. It sets a quality bar, which is why we have such high-quality television and radio in this country. At this point, it is traditional for a Member taking part in such a debate to praise his local radio station, so let me say that I think that BBC Radio Oxford is the finest local radio station in the country. That will now appear as a jingle this week on BBC Radio Oxford.
	More seriously, may I also praise BBC Worldwide for its success, led by its extremely effective chief executive, John Smith? It makes a significant income for the BBC.
	Many topics were covered in the debate, and I have four minutes in which to deal with them. First, I hear what my hon. Friend had to say about impartiality and the BBC. We all have views and might occasionally throw something at the television when we see an item that we think is unfair. The BBC, in the consultation document from the new chairman of the BBC Trust, has said that it is aware of those concerns and will now have annual impartiality reviews. It sounds rather Orwellian, but the BBC is going to have impartiality seminars for staff, where they will be re-educated away from their partial tendencies towards impartial tendencies.
	I heard my hon. Friend speak of his concerns about BBC 3 and BBC 4. They are not watched by many, but they are loved by a few. Again, it is an indication of taste that in the litany of programmes of which he disapproved, one shone out—“Total Wipeout”—of which I have become a great fan, because I can watch it with my young children.
	I share my hon. Friend’s concerns about the level of salaries at the BBC. I am not sure I agree with the assertion that the people who earn these salaries could earn significantly more in the outside world. If such people could triple their salaries there, one wonders why they are not going into the outside world. We have made progress in transparency, at least. I hear his concern about what talent is paid, particularly the talent who uses their platform on the BBC to make significant outside earnings by speaking at corporate events, which are not declared by the BBC.
	The new chairman of the BBC Trust, Chris Patten, is a welcome appointment. I am pleased that we have a licence fee freeze. That will be good for the licence fee payer. Although the hon. Member for Great Grimsby, Cassandra-like, predicts doom for the BBC under the licence fee freeze, my glass is half-full in that respect. What the BBC has, which other media companies do not have, is certainty of income for the next six years.
	There will be a charter review. The new charter must be concluded by the end of 2016. It may be that we take into account the views of my hon. Friend the Member for Harlow (Robert Halfon) who, since he entered the House, has made a fantastic impact. I wonder, though, whether his proposals might be somewhat expensive.
	May I also praise my hon. Friend the Member for Morecambe and Lunesdale (David Morris) for his
	contribution—I am told that he used to be in a band, but it is not in
	Vacher
	’
	s
	, so I would like to know which band it was—and my hon. Friend the Member for Colne Valley (Jason McCartney), who highlighted the importance of local radio?
	I conclude by saying that I thoroughly enjoyed the debate. If anyone wants to know about my own political obsessions, let me point out that my devotion to Parliament and to the BBC mean that once I watched the Parliament channel where, in archive footage, I saw the hon. Member for Great Grimsby in his younger days debating the merits of televising Parliament.
	Question put and agreed to.
	House adjourned.